扩大肝切除术治疗Ⅲ至Ⅳ期肝门胆管癌的临床价值

Clinical significance of extended hepatic resection in the treatment of hilar cholangiocarcinoma in stage Ⅲ-Ⅳ

目的研究扩大肝切除术治疗Ⅲ至Ⅳ期肝门胆管癌的临床价值。方法选取70例Ⅲ~Ⅳ期肝门胆管癌患者,根据治疗方式不同分为观察组和对照组,每组各35例。其中对照组采用局限肝切除术治疗,观察组采用扩大肝切除术治疗,比较两组患者的手术时间、术中出血量、住院时间、总胆红素、直接胆红素、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、根治性切除率、术后并发症发生率以及生存率。结果观察组患者的手术时间明显长于对照组,术中出血量明显高于对照组,住院时间明显短于对照组,差异均有统计学意义(P﹤0.01);治疗后,两组患者的总胆红素、直接胆红素、ALT及AST比较,差异均无统计学意义(P﹥0.05);观察组患者的根治性切除率(91.43%)明显高于对照组(65.71%),差异有统计学意义(P﹤0.01);观察组患者的3年生存率高于对照组,差异有统计学意义(P﹤0.05)。结论扩大肝切除术治疗Ⅲ至Ⅳ期肝门胆管癌的临床疗效显著,可有效提高根治性切除率,延长患者生存时间,预后效果明显。

Objective To study the clinical significance of extended hepatic resection in the treatment of patients with hilar cholangiocarcinoma in stage Ⅲ - Ⅳ. Method 70 cases of hilar cholangiocarcinoma in stage Ⅲ-Ⅳ were included and grouped by respective therapy as study or control group, with 35 cases in each, which were administered with extend- ed or limited hepatic resection, respectively, and the operative time, intraoperative blood loss, hospital stay, total bilirubin, direct bilirubin, ALT, AST, radical resection rate, postoperative complication rate and survival rate of the two groups were analyzed. Result The study group had longer operative time, more intraoperative blood loss, and shorter hospital stay than control group （P 〈 0.01）; after treatment, the total bilirubin, direct bilirubin, ALT and AST in both groups were com- parable （P 〉 0.05）; the study group had higher radical resection （91.43%） than that of control group （65.71%） （P 〈 0.01）; similar result was observed for 3-year survival rate （P 〈 0.05）. Conclusion Extended hepatic resection is quite effective in the treatment of patients with hilar cholangiocarcinoma in stage Ⅲ-Ⅳ, with increased radical resection rate, prolonged survival time, and improved prognosis.