中晚期肝门部胆管癌15例手术切除体会

目的探讨中晚期肝门部胆管癌的外科治疗方式。方法对2002年12月—2005年10月收治的15例中晚期肝门部胆管癌的外科治疗方式和随访结果进行回顾性分析,其中中期7例(BismuthⅢa型4例,Ⅲb型3例),晚期(Ⅳ型)8例。结果手术切除10例,非手术胆道支架内引流5例(Ⅳ型5例)。随访14例(14/15,93.3%),手术切除组随访10例,中位生存期14.2月(16d～32.3月);非手术胆道支架内引流组随访4例,中位生存期3.8月(1.3～7.2月),两组中位生存期差异显著(t=2.802,P<0.05)。结论对于中晚期肝门部胆管癌,联合肝切除的姑息性肝门部胆管癌切除可显著延长患者生存期、提高生活质量,必要时,辅以“架桥式”肝管空肠内引流对提高手术切除率、降低术后胆漏发生率具有重要作用。

Experience of Surgical Operation in 15 Cases of Medium-term and Advanced Bile Duct Carcinoma in Porta Hepatis

Objective To discuss the surgical therapeutic approach to medium-term and advanced bile duct carcinoma in porta hepatis. MethodsSurgical therapeutic approach and follow-up outcome were retrospectively analyzed in 15 cases of medium-term and advanced bile duct carcinoma in porta hepatis,among which medium-term tumor accounted for seven (4,Bismuth Ⅲa;3,Ⅲb) and advanced tumor accounted for eight cases (Bismuth IV). ResultsSurgical removal was performed in ten cases, and non-surgical drainage through the bridge between hepatic bile duct and jejunum was done in five cases (Bismuth IV). Among the 14 cases (14/15, 93.3%) who were followed up, ten cases belonged to the surgical removal group and had a median survival of 14.2 months, and four cases belonged to the non-surgical drainage group and had a median survival of 3.8 months. There was a significant difference in the median survival between the two groups (t=2.802,P<0.05). ConclusionThe palliative operation of bile duct carcinoma in porta hepatic, combined with local hepatic removal, can prolong the survival time and improve the life qualities of the patients.