肝门部胆管癌的临床诊断与手术治疗分析

Diagnosis and surgical treatment of patients with hilar cholangiocarcinoma

目的探讨肝门部胆管癌的临床诊断方法及两种不同手术方法的预后。方法选取2002年12月至2008年3月就诊的肝门部胆管癌患者43例作为研究对象,回顾性分析所有患者的临床表现、影像学检查结果、手术方式、生存率等临床资料,所有对象按手术方法分为根治性切除术组(22例)和姑息性切除术组(21例),对比分析两组间患者的术后并发症发生率,1、3、5年生存率有无统计学差异。结果临床表现以黄疸最为常见,占86.0%,其次是尿黄(81.4%)和皮肤瘙痒(72.1%);经过常规超声、CT及MRI联合检查,根治性切除术组和姑息性切除术组对肝门部胆管癌检出率分别为90.9%和95.2%;MRI诊断阳性率明显高于超声诊断阳性率(χ2=7.379,P<0.01)。根治性切除术组患者并发症发生率明显高于姑息性切除术组(χ2=14.321,P<0.01),1、3、5年生存率也明显高于姑息性切除术组(χ2=6.018、χ2=2.842、χ2=17.483,P<0.05)。结论对于肝门部胆管癌患者,MRI诊断阳性率明显高于超声,采取超声联合CT或MRI可提高早期诊断率;根治性切除术治疗肝门部胆管癌,能够提高此类患者的远期存活率。

Objectives To investigate the clinical diagnosis of hilar cholangiocarcinoma and its prognosis by two surgical treatments. Methods Fourty-three patients with hilar cholangiocarcinoma were enrolled in this study at our hospital. The clinical features, imaging results, surgical methods, and survival rates of all the patients were analyzed retrospectively. The patients were divided into 2 groups： a radical excision group （ n = 22 ） and a palliative resection group （ n = 21 ）. The incidence of complications, the 1-year survival rates, the 3-years survival rates, and the 5-years survival rates were compared between the 2 groups. Results ： The clinical characteristics of hilar cholangiocarcinoma include jaundice （86.0%）, yellow urine（81.4% ）and cutaneous pruritus（72.1% ）. By using ultrasound, CT, and MRI, the diagnosis rate of the radical excision group and the palliative resection group was 90.9% and 95.2%, respectively. The positive diagnostic rate of MRI was significantly higher than that of ultrasound （χ^2 = 7. 379 ,P 〈 0. 01 ）. The incidence rate of complications of the radical excision group was significantly higher than that of the palliative resection group （χ^2 = 14. 321 ,P 〈 0.01 ）. The complication rate, 1-year survival rate, 3-yearsurvival rate, and 5-year survival rate of the radical excision group were significantly higher （χ^2 = 6. 018 ,χ^2 = 2. 842, χ^2 = 17.483 ,P 〈 0.05 ） than those of the palliative resection group. Conclusions For the patients with hilar cholangiocarcinoma, the positive diagnostic rate of MRI was significantly higher than that of ultrasound. Imaging examinations combined with ultrasound and CT/MRI could improve the early diagnosis rate. Radical excision could improve the survival rate of patients with hilar cholangiocareinoma.