外科治疗胆管癌32例分析

ANALYSIS OF SURGICAL THERAPY IN 32 CASES OF BILE DUCT CARCINOMA

胆管癌发病率有逐渐增多的趋势。本文回顾我院1980年1月至1989年12月,经手术及病理证实的原发性肝外胆管癌32例,其中上段胆管癌21例(65.6%),中段5例(15.6%),下段6例(18.8%),现分析如下。

This paper analyses the surgical therapy in 32 cases of bile duct carcinoma, Bile duct carcinoma in this series were found in the upper bile ducts in 21 patients (65.6%), in the midportion of the bile duct in 5 patients (15.6%), and in the lower portion in 6 patients (18.8%). Of the 32 cases, 13 were associated with cholelithiasis, 14 associated with chronic cholangitis and 8 associated with clonorchiasis, stimulated by stones, chronic inflammation, and clonorchis worm bodies and their secretions in long term, the epithelium of the bile ducts may be proliferated, even abnormal proliferation, and carcinoma formed ultimately. The symptoms and signs are dependent upon the position and size of the tumor. special laboratorial methods for bile duct carcinoma at the present time are defective. Imaging examinations in the diagnosis of bile duct carcinoma are very important, being noninvasive and cheaper. Of 29 patients, all of them presented hepatocholangiectasis, and 16 showed reflexion of the tumor's light beam. 19 presented hepatocholangiectasis above the tumor's level and the bile duct was filling defect in the tumor's position. The ideal treatment of the bile duct carcinoma is radical resection. Palliative operations Include the biliary internal and external drainage, the biliary internal drainage is better than the external. In the patients whose hilar bile ducts are locked by tumor, Quadrate lobe hepatectomy can expose the hilar bile ducts clearly, so that it offers more chance to remove the bile duct carcinoma and the surgeon can easily finish hepatojejunostomy.