下段胆管癌85例的诊断与治疗

The diagnosis and treatment of distal bile duct carcinoma: report of 85 cases

目的 探讨下段胆管癌的诊断和治疗方法、降低术后并发症。方法 回顾性总结 85例下段胆管癌的临床资料。结果 本组 85例均接受手术治疗 ,其中 45例行根治性胰十二指肠切除术 ,40例经各种引流术式进行减黄 ,手术切除率 5 3% (4 5 /85 )。根治组与减黄组 1、2、3、5、8年的生存率分别为 6 7%、49%、2 2 %、9%、2 %及 35 %、10 %、5 %、0、0。术前经胰胆管造影术 (ERCP)检查者 15例 ,并发急性重症胆管炎者占 40 % (6 /15 ) ,且均死于感染性休克。结论 重视疾病早期症状 ,早期诊断、早期治疗 ,行根治性胰十二指肠切除术是最有效的治疗措施 ,可减少经内镜逆行胰胆管造影后的并发症 ,能有效地降低手术死亡率。

Objective [WT5”BZ] To evaluate the diagnosis and treatment of the distal bile duct carcinoma and to reduce the complication of preoperative diagnostic ERCP.[WT5”HZ] Method [WT5”BZ] The clinical data of 85 cases with the distal bile duct carcinoma was reviewed. [WT5”HZ]Results [WT5”BZ] 45 cases underwent radical pancreatoduodenectomy, 40 cases were [CM(43]treated by internal bile duct drainage procedures. The resection rate was 53%(45/85). The 1-, 2-, 3-, 5-, 8-years survival rates were 67%, 49%, 22%, 9%, 2% and 35%, 10%, 5%, 0, 0 respectively. Among 15 cases undergoing preoperative ERCP,six (40%) developed mortal suppurative cholangitis (AOSC). [WT5”HZ]Conclusions [WT5”BZ] Early diagnosis and curative resection is the key to prolong postoperative survival. Preoperative ERCP is a procedure full of danger in patients with distal comman bile duct carcinoma. [WT5”HZ]