肝门部胆管癌姑息性手术179例

The palliative surgery for hilar cholangiocarcinoma in 179 cases

目的探讨肝门部胆管癌姑息性手术的术式选择。方法对近 2 0年来 179例姑息性手术治疗的肝门部胆管癌患者临床资料进行回顾性分析。结果手术病死率 10 1% ,各组间无显著差异 ;术后复发性胆管炎发生率 :胆肠Roux en Y吻合术组及桥式内引流术组 (15 1%及 10 0 % )显著低于PTCD(或ERBD)内引流术组及开腹 (或PTCD)外引流术组 (35 7%及 38 1% ) (P <0 0 1) ;术后生存期 :胆肠Roux en Y吻合术组 (9 2± 1 7个月 )与PTCD(或ERBD)内引流术组 (8 8± 2 1个月 )无显著差异 ,与桥式内引流术组 (6 5± 1 8个月 )差异有显著意义 (P <0 0 5 ) ,与开腹 (或PTCD)外引流术组(4 4± 2 1个月 )和单纯开腹探查术组 (3 2± 1 4个月 )比较差异有显著意义 (P <0 0 1)。结论肝门部胆管癌姑息性手术应首选胆肠Roux en Y术式 ,同时应用U型管做内支撑引流管并行内照射治疗 ,可明显提高术后生活质量 。

ObjectiveTo evaluate result of palliative operation for hilar cholangiocarcinoma. Methods The clinical data of 179 cases of cholangiocarcinoma during the last 20 years were analysed retrospectively. Results The operative mortality rate was 10 1%, there was no significant difference between the groups. The rate of cholangitis after operation in the Roux en Y choledochjejunostomy group (15 1%) and bridge internal drainage group (10 0%) was significantly lower than that of PTCD (or ERBD) internal drainage group (35 7%, P <0 01) and surgical (or PTCD) external drainage group (38 1%, P <0 01). There was no significant difference between Roux en Y choledochojejunostomy group (9 2±1 7 months) and PTCD (or ERBD) internal drainage group (8 8±2 1 months) in survival period,but the survival period of the above groups were significantly longer than that of bridge internal drainage (6 5±1 8 months, P <0 05), and operative (or PTCD) external drainage group (4 4±2 1 months, P <0 01). ConclusionsRoux en Y choledochjejunostomy is first choice for palliative operation. Use of U tube is recommended for internal radiation therapy.