肝门部胆管癌的根治性切除术:附38例报告

The radical resection of hilar cholangiocarcinoma:a report of 38 cases

目的 探讨肝门部胆管癌的诊断及根治性切除方法。方法 回顾性分析 3 8例肝门部胆癌的临床特点、根治性切除方法及治疗效果。结果 术前均诊断明确。根治性切除 3 8例 ,手术死亡3例 ( 7.9% )。术后并发胆漏 5例 ( 13 .2 % ) ,其中 2例并膈下脓肿 ,均经引流或再次手术引流治愈 ;右胸腔积液 4例 ( 10 .5 % ) ,均经保守治疗治愈 ;切口裂开 3例 ( 7.9% ) ,经再次缝合治愈。术后生存的 3 5例中 ,有 3 4例 ( 97.1% )获得随访 ,1,3年生存率分别为 91.9% ,3 5 .2 % ,无 5年生存者。结论 肝门部胆管癌早期诊断困难 ,联合应用影像学检查可明确诊断。目前根治性切除率仍较低 ,术后易复发和转移 ,鲜有长期生存者。提示即使是根治性手术 ,其切除和清扫范围可能仍然不够 ,其治疗手段有待进一步改进。

Objective To study the diagnosis and radical resection of hilar cholangiocarcinoma. Methods Retrospective analysis was made on the clinical feature and the effect of radical resection on 38 cases of hilar cholangiocarcinomas.Results Diagnosis was made in all of the patients preoperatively.The radical resection was perfomed on 38 patients.Of them, 3(7.9%) died after operation.After operation, 5 cases (13.2%) developed bile leakage,and 2 of the 5 cases developed subphrenic abscess,which were cured by drainage; 4(10.5%) had right hydrothorax that was cured by conservative therapy; and 3(7.9%)had incision split that was cured by resuture. Among the 35 postoperative survivors,34 (97.1%) were followed up, the 1- and 3-year survival rates were 91.9% and 35.2%.None of the patients survived for 5 years. Conclusions It′s still difficult to make early diagnosis in hilar cholangiocarcinoma.The diagnosis mainly depends on the combination of imaging examinations. Nowadays the radical resection rate of hilar cholangiocarunoma is still low, the recurrence and metastasis are common after operation, and few patients can survive for a long time. It suggests that even in radical operation for hilar cholangiocarcinoma, the regions of resection and sweep are not enough,and the operative procedure needs to improve further.