肝门部胆管癌的外科治疗

The surgical treatment of hilar bile duct carcinoma

目的 分析一个单位 1986-2 0 0 2年间治疗肝门部胆管癌的经验。方法 回顾 1986-2 0 0 2年在解放军总医院肝胆外科治疗 2 91例肝门部胆管癌的纪录 ,全部治疗均在单一的科室技术领导下进行 ,有一定的连贯性。外科治疗手段主要是依据手术中所发现的病理情况决定。根治性切除术的标准是指切除的边缘病理上未发现残留癌细胞者。结果 在我国 ,肝外胆管癌是并非少见的疾病 ,近年来手术治疗的病例数有增多倾向。然而 ,根治性切除手术有困难 ,甚至联合肝切除亦难以达到根治目的 ,因而根治性切除率只分别为 3 7.6%和 41.2 %。无切除术后 3 0d内死亡。有 4例病人于切除术后长期无瘤生存 ,5年以上生存率为 13 .3 % ;另有 2例病人亦生存达 5年以上 ,但癌复发 ,现仍在接受进一步治疗。结论 肝门部胆管癌是多态性的疾病 ,只是极少数表现为较“良性”的倾向 ,而绝大多数则于手术切除后易于复发 ,虽然手术似乎是已达治愈性。切除性治疗 ,甚至是姑息性切除 ,仍可以达到延长生命和提高生活质量的效果。

Objective To summarize the clinical experience in the treatment of hilar bile duct carcinoma in a single institution. Methods From 1986 to 1992, 291 cases of hilar bile duct carcinoma were admitted to the Hepato-Biliary Department of The General Hospital of PLA, Beijing. During this period, methods of surgical treatment for hilar bile duct cancer was adopted under the guidance of the senior author. Results Carcinoma of the proximal extrahepatic bile duct was not a rare disease in China. Owing to the location of the tumor, radical resection was difficult to reach even supplemented by liver lobectomy. Radical resection (free of residual tumor cells at the resection edge of the resected specimens) was 37.6% to41.2%. There was no death within 30 days after resectional treatment. There were four cases of tumor-free 5-year survivals (13.3%) and two cases living for more than 5 years but with tumor recurrence. Conclusions Carcinoma of the hilar bile duct is a disease of multiformity. Rarely, it may behave a rather benign course, but, in the majority, the disease was likely to be recurrent even after a seemingly radical resection. However, resectional treatment, even palliative, may prolong life and improve the quality of living. The value of extended resection and lymph nodes dissection operation is still uncertain.