肝门部胆管癌的诊断和外科治疗(附27例报告)

Diagnosis and surgical treatment of 27 cases with hilar bile duct carcinoma

目的:探讨肝门部胆管癌的诊断和外科处理及其预后。方法:对经手术和病理检查确诊的肝门部胆管癌27例的临床特征、手术方式和随访结果进行回顾性分析。结果:切除7例,其中根治性切除2例,姑息性切除5例。胆肠吻合4例,单纯探查活检6例,胆道支架置入3例,胆道外引流7例。根治性切除2例健康生存1年。姑息性切除、胆肠吻合和胆道支架置入的1年生存率分别为40%,0和33.3%。结论:应力争进行肝门部胆管癌的根治性切除。当根治性切除无法施行时,可考虑其他外科处理方式。

Objective:To evaluate the diagnosis and surgical treatment for hilar bile duct carcinoma and its prognosis. Methods:The clinico-pathological variables and the follow-up data of 27 patients with hilar bile duct carcinoma were retrospectively analyzed. Results:Resection was performed in 7 patients ( radical resection in 2, palliative resection in 5), choledochojejunostomy in 4 cases, laparotomy in 6 cases and stent placement in 3 cases. The 1-year survival rate of the patients treated with radical resection was 100%. The 1-year survival rate of those treated with palliative resection, choledochojejunostomy and stent placement were 40%, 0 and 33.3%, respectively. Conclusion:Radical resection is the first choice forhilarbile duct carcinoma. Other surgical treatment for the hilar bile duct carcinoma is the secondary treatment when radical resection fails.