肝门部胆管癌根治性切除手术方式的改进

目的 规范肝门部胆管癌整块或根治性切除术的手术方式，改进和提高其手术治疗效果。方法 总结分析了解放军总医院１９８６年至１９９９年手术治疗的肝门部胆管癌１５７例资料。结果 总手术切除率为６７.５％（１０６／１５７），根治性切除率为３７.６％（５９／１５７）。近３年对５４例肝门部胆管癌行手术切除，切除率为７４％（４１／５４），根治性切除率为４３％（２３／５４）；随访年存活率：根治性切除组为５７％（１３／２３），姑息性切除组为４１％（７／１７），未切除组为７％（１／１４）。结论 术中病理诊断是选择根治性切除术的重要参考指标。

A new radical resection for hilar cholangiocarcinoma

Objective To evaluate a newly designed radical resection for hilar cholangiocarcinoma in terms of higher resection rate and longer survival.HZ]Methods A retrospective analysis was made on 157 patients undergoing radical operation for hilar cholangiocarcinoma from 1986 to 1999.Results The total resection rate and the radical resection rate was 67.5% (106/157) and 37.6% (59/157), respectively, whereas among 54 cases undergoing surgery during recent 3 years it was 74% (41/54) and 43% (23/54) respectively. The 3 year survival rate of radical resection,palliative resection and non resection was 57% (13/23),41% (7/17) and 7% (1/14) . Conclusion Intraoperative pathological diagnosis plays an important role in the selection of radical resection. The improvements of radical resection of hilar cholangiocarcinoma are as follows: (1) transection of proximal hepatic bile duct at the porta hepatis; (2) skeletoning the portal vein combined with resection of the hepatica propria artery; (3) excision of portal vein plus hemihepatectomy; (4) cholangiojejunostomy without internal stent.