BACKGROUND: Hepatic hilar cholangiocarcinoma can be diagnosed early with the progress in diagnostic imaging, and thus the rate of resection of the tumor has increased markedly. To assess the effectiveness of resection...BACKGROUND: Hepatic hilar cholangiocarcinoma can be diagnosed early with the progress in diagnostic imaging, and thus the rate of resection of the tumor has increased markedly. To assess the effectiveness of resection, we reviewed 185 cases of hepatic hilar cholangiocarcinoma diagnosed and treated at our hospital. METHODS: The clinical data of 185 patients with hepatic hilar cholangiocarcinoma who had been treated surgically from 1972 to 2006 were retrospectively analyzed. RESULTS: The records of the 185 patients were divided into first stage (1972-1986) or second stage (1987-2006) according to the incidence of the tumor and its resection rate. Primary symptoms included upper abdominal discomfort or pain, anorexia, tiredness, weight loss and progressive jaundice. Ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and magnetic resonance cholangiopancreatography (MRCP) were first line methods for atraumatic diagnosis. If the patients displayed intrahepatic bile duct dilatation or were diagnosed as suffering from extrahepatic obstructive jaundice, percutaneous transhepatic cholangiography (PTC), MRCP or endoscopic retrograde cholangiopancreatography (ERCP) should be used. In this series, 87 patients underwent resection of the tumor (47.0%). Of the 87 patients, 43 received radical resection and 44 palliative resection. Fifteen patients underwent resection in the first stage and 72 in the second stage. A total of 74 patients were followed up after the resection. The median survival time of the radical resection group was 37 months and that of the palliative resection group was 17 months (P<0.001). The other 62 patients receiving no resection died within 1.5 years. CONCLUSIONS: Once patients are diagnosed with hepatic hilar cholangiocarcinoma, they should undergo exploratory laparotomy. Resection is the most effective method for the treatment of hepatic hilar cholangiocarcinoma.展开更多
目的基于倾向性评分匹配(PSM)分析腹腔镜肝门部胆管癌根治术的安全性。方法回顾性分析2016年1月至2021年12月在重庆医科大学附属第一医院行肝门部胆管癌根治术的48例患者临床资料。其中男27例,女21例;年龄37~76岁,中位年龄67岁。患者均...目的基于倾向性评分匹配(PSM)分析腹腔镜肝门部胆管癌根治术的安全性。方法回顾性分析2016年1月至2021年12月在重庆医科大学附属第一医院行肝门部胆管癌根治术的48例患者临床资料。其中男27例,女21例;年龄37~76岁,中位年龄67岁。患者均签署知情同意书,符合医学伦理学规定。根据手术方式将其分为腹腔镜组(10例)和开腹组(38例)。采用倾向性评分匹配(PSM)对腹腔镜组与开腹组进行1∶1匹配,匹配后两组各10例。比较两组患者围手术期情况。两组手术时间比较采用t检验;术中出血量、术后1 d视觉模拟评分(VAS)、术后住院时间比较采用秩和检验;术中输血率、严重并发症发生率比较采用Fisher确切概率法。结果PSM后腹腔镜组和开腹组平均手术时间分别为(429±100)、(364±97)min,差异无统计学意义(t=1.484,P>0.05)。两组术中出血量中位数分别为300(325)、250(225)ml,术后1 d VAS评分分别为2.5(2.0)、3.0(1.0)分,术后住院时间分别为16(6)、18(8)d,差异无统计学意义(Z=0.733,-0.457,-0.682;P>0.05)。两组术中输血分别为3、1例,术后胆漏分别为0、1例,差异亦无统计学意义(P=0.276,0.371)。结论在腹腔镜技术成熟及手术配合熟练的团队,腹腔镜应用于肝门部胆管癌根治术中是安全、可行的,与传统开腹手术围手术期安全性无明显差异。展开更多
文摘BACKGROUND: Hepatic hilar cholangiocarcinoma can be diagnosed early with the progress in diagnostic imaging, and thus the rate of resection of the tumor has increased markedly. To assess the effectiveness of resection, we reviewed 185 cases of hepatic hilar cholangiocarcinoma diagnosed and treated at our hospital. METHODS: The clinical data of 185 patients with hepatic hilar cholangiocarcinoma who had been treated surgically from 1972 to 2006 were retrospectively analyzed. RESULTS: The records of the 185 patients were divided into first stage (1972-1986) or second stage (1987-2006) according to the incidence of the tumor and its resection rate. Primary symptoms included upper abdominal discomfort or pain, anorexia, tiredness, weight loss and progressive jaundice. Ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and magnetic resonance cholangiopancreatography (MRCP) were first line methods for atraumatic diagnosis. If the patients displayed intrahepatic bile duct dilatation or were diagnosed as suffering from extrahepatic obstructive jaundice, percutaneous transhepatic cholangiography (PTC), MRCP or endoscopic retrograde cholangiopancreatography (ERCP) should be used. In this series, 87 patients underwent resection of the tumor (47.0%). Of the 87 patients, 43 received radical resection and 44 palliative resection. Fifteen patients underwent resection in the first stage and 72 in the second stage. A total of 74 patients were followed up after the resection. The median survival time of the radical resection group was 37 months and that of the palliative resection group was 17 months (P<0.001). The other 62 patients receiving no resection died within 1.5 years. CONCLUSIONS: Once patients are diagnosed with hepatic hilar cholangiocarcinoma, they should undergo exploratory laparotomy. Resection is the most effective method for the treatment of hepatic hilar cholangiocarcinoma.
文摘目的基于倾向性评分匹配(PSM)分析腹腔镜肝门部胆管癌根治术的安全性。方法回顾性分析2016年1月至2021年12月在重庆医科大学附属第一医院行肝门部胆管癌根治术的48例患者临床资料。其中男27例,女21例;年龄37~76岁,中位年龄67岁。患者均签署知情同意书,符合医学伦理学规定。根据手术方式将其分为腹腔镜组(10例)和开腹组(38例)。采用倾向性评分匹配(PSM)对腹腔镜组与开腹组进行1∶1匹配,匹配后两组各10例。比较两组患者围手术期情况。两组手术时间比较采用t检验;术中出血量、术后1 d视觉模拟评分(VAS)、术后住院时间比较采用秩和检验;术中输血率、严重并发症发生率比较采用Fisher确切概率法。结果PSM后腹腔镜组和开腹组平均手术时间分别为(429±100)、(364±97)min,差异无统计学意义(t=1.484,P>0.05)。两组术中出血量中位数分别为300(325)、250(225)ml,术后1 d VAS评分分别为2.5(2.0)、3.0(1.0)分,术后住院时间分别为16(6)、18(8)d,差异无统计学意义(Z=0.733,-0.457,-0.682;P>0.05)。两组术中输血分别为3、1例,术后胆漏分别为0、1例,差异亦无统计学意义(P=0.276,0.371)。结论在腹腔镜技术成熟及手术配合熟练的团队,腹腔镜应用于肝门部胆管癌根治术中是安全、可行的,与传统开腹手术围手术期安全性无明显差异。
