近端胆管癌的外科治疗

目的 探讨近端胆管癌的外科治疗及疗效。方法 57例近端胆管癌患21斧正行外科手术治疗，36例行非手术外引流治疗。结果 21例手术治疗患中17例存活14月以上，36例行鼻胆管引流或内置管引流术患均在8月内死亡。结论 外科手术治疗近端胆管癌疗效明显优于鼻胆管引流术（ENBD）或内置管引流术（ERBD）胆管内外引流。     

肝外近端胆管癌治疗的现状(综述)

近端胆管癌的早期诊断不易,切除平低,近年来其发生率有增长趋势,本文重点就其病理特色,诊断和各种治疗方法作一回顾性介绍,供临床参考.     

肝外近端胆管癌治疗的现状（综述）

近端管癌的早期诊断不易，切除率低，近年来其发生率有增长趋势，本文重点就其病理特点，诊断和各种治疗方法作一回顾性介绍，供临床参考。     

肝门部胆管癌的外科治疗57例报道

目的探讨近端胆管癌的外科治疗及其疗效。方法57例近端胆管癌患者中21例行外科手术,36例行非手术外引流。结果21例手术治疗患者中17例存活14个月以上,36例行鼻胆管引流或内置管引流术患者均在8个月内死亡。结论外科手术治疗近端胆管癌疗效明显优于内镜鼻胆管引流（ENBD）或内镜内置管引流（ERBD）。     

胆管癌30例的诊断和外科治疗

目的 提高对胆管癌的诊断与外科治疗水平。方法 对1991—2001年经手术治疗且病理证实的30例胆管癌进行回顾性分析。结果 术前早期诊断率低，总手术切除率66．7％，其中根治性切除率16．7％，姑息性切除率50％。随访22例：根治性切除组平均生存期18．6个月，姑息性切除组平均生存期13．5个月；姑息性切除组中合并镍钛胆道支架、胆肠吻合术者平均生存期明显长于单纯外引流组。结论 早期诊断、根治性切除是提高治疗效果的关键，姑息性切除和镍钛记忆合金胆道支架具有改善生活质量、延长生存期的疗效。     

高位胆管癌32例外科治疗

目的 探讨高位胆管癌的诊断方法和外科治疗的疗效。方法 对1995年1月-2000年12月我院收治的32例高位胆管癌的临床特点、诊断、手术方法和随诊结果进行回顾性分析。结果 手术切除12例，切除率为37．5％。其中行根治性切除9例，均存活18个月以上。姑息性切除3例，2例存活超过18个月。内、外引流术20例，均于术后1～18个月内死亡。结论 根治性切除可显著延长患者生存期，是治疗高位胆管癌首选术式。     

肝门胆管癌外科治疗的几个热点问题

胆管癌指起源于胆管上皮的恶性肿瘤.胆管癌可发生于胆道系统的不同部位,因此临床将其分别命名为肝内胆管癌（Intrahepatic cholangiocarcinoma,JCC）和肝外胆管癌（Extrahepatic cholangiocarcinoma,ECC）两大类型.其中,ECC以胆囊管与肝总管的交汇点为界限,分别命名为起源于此交汇点上的近端胆管癌和起源于此交汇点之下的远端胆管癌.近端胆管癌后改称为肝门胆管癌（Hilar cholangiocarcinoma,HCC）,而远端胆管癌常指胆总管癌.HCC解剖学定位包括起源于肝门部左肝管、右肝管、肝总管、以及三者汇合部的恶性肿瘤,由于肿瘤的进展,可以在单侧或双侧累及Ⅰ级或Ⅱ级肝内胆管.HCC的主要病理类型是腺癌,常可产黏液,少见类型包括腺鳞癌、未分化癌和神经内分泌肿瘤等.     

肝门部胆管癌的外科治疗

目的 探讨肝门部胆管癌各种术式的疗效。方法 回顾性分析经手术和病理证实的肝门部胆管癌35例手术方式和随访结果。结果 手术切除13例（根治性切除9例,姑息性切除4例）,总手术切除率为37．1％,其中1996年以后的23例中切除12例,手术切除率为52．2％;胆管内引流5例;外引流1例;剖腹探查6例。随访23例,随访率65．7％。切除术组13例,存活7－30个月,平均17．5个月,现仍存活4例,生存期分别为12,13,15和21个月;引流组存活2．5－24个月,平均9．2个月,1例已生存13个月;单纯剖腹探查术者多于术后3个月内死亡。结论 根治性切除和扩大手术切除范围是肝门部胆管癌首选的治疗方法。对不能切除者,不应放弃手术探查,应争取行胆管内、外引流术。     

肱骨近端粉碎骨折的外科治疗

自1999年1月～2003年3月采用手术方法治疗肱骨近端粉碎骨折26例,报告如下。     

肝门部胆管癌的外科治疗

目的探讨肝门部胆管癌的诊断和外科治疗的效果.方法对46例肝门部胆管癌的临床资料进行回顾性分析.结果本组术前误诊率43.5%(20/46).18例手术切除,总手术切除率39.1%(18/46),其中根治性切除率26.1%(12/46);22例行周围胆管空肠吻合术;6例U管引流术.根治切除、姑息切除、胆管空肠吻合和U管引流组病人的平均生存期分别是(20.32±11.24)月,(18.12±10.43)月,(12.46±8.78)月和(7.32±5.24)月.切除组病人的生存期显著长于姑息性手术组(P<0.01),而且生活质量显著提高.结论临床医生应重视肝门部胆管癌的早期诊断.根治切除术可显著延长患者生存期和改善生存质量.     

Surgical treatment for hilar cholangiocarcinoma

From September 1976 to February 1998, we experienced 75 resected patients with hilar cholangiocarcinoma. Curative resection was performed in 45 patients (60.0%), with a cumulative 5-year survival rate of 39.8%. In this retrospective study, we compared therapeutic outcomes in these 75 patients according to the period during which they were treated; (1) 12 patients in the early period (September 1976 to August 1981) chiefly treated by bile duct resection, (2) 50 patients in the middle period, September 1981 to August 1994, chiefly treated by aggressive surgical procedures with extensive hepatectomy plus caudate lobe resection, and (3) 13 patients in the late period, September 1994 to February 1998, during which percutaneous transhepatic portal embolization was introduced to increase the safety and curability of extended hepatectomy, and limited hepatectomy was selected according to tumor spread. In the late period, total resection of the caudate lobe was done in all patients, with the aim being thorough resection of cancer cells in the caudate lobe. The curative resection rates were 16.7% in the early period, 64.0% in the middle period, and 84.6% in the late period, showing an improvement year-by-year (P < 0.05; early period vs middle period and late period). All patients in the early period died within 2 years of resection, whereas the 5-year survival rate in the middle period was 24.4%, significantly improved (P < 0.05) compared with the early period. The 1- and 3-year survival rates of 84.6% and 58.0%, respectively, in the late period, show an even greater improvement in outcome. Received for publication on Oct. 5, 1998; accepted on Oct. 5, 1998     

56例肝门部胆管癌外科治疗体会

目的 探讨肝门部胆管癌的诊断方法和外科治疗的疗效.方法 回顾性分析1996年1月至2006年1月间对56例肝门部胆管癌诊疗的临床资料及随访结果.结果 应用B超及MR等多种影像学技术对肝门部胆管癌的定位诊断率100%.56例行手术治疗,其中探查术5例,内、外引流术23例,均于术后2～15个月死亡.切除术28例(50.0%),行根治性切除24例(42.9%).中位生存期为29个月,姑息性切除4例,中住生存期为12个月.结论 超声检查联合MRCP能对肝门部胆管癌的定位诊断及评判手术切除有重要价值;根治性切除是改善肝门部胆管癌疗效的重要措施.     

肝门部胆管癌的外科治疗

目的探讨肝门部胆管癌的外科手术治疗的方法及其效果。方法对96例肝门部胆管癌患者外科手术治疗的方法及疗进行回顾性分析。根治性切除术33例,姑息性切除17例,内和外引流46例。结果手术病死率9.4%,各组间差异无统计意义。手术切除率52%,其中根治性切除率34%;根治性切除、姑息性切除、内引流和外引流组术后生存时间为30、17、13、2.9个月。结论根治性切除是肝门部胆管癌有效的治疗手段,对无法行根治性切除者以内引流为首选治疗方法,能提高患者术后生活质量,延长生存期。     

Aggressive surgical treatment of hilar cholangiocarcinoma

Recent progress in surgical techniques for and the perioperative management of hilar cholangiocarcinoma has led to improved outcomes for aggressive liver and bile duct resections, which, however, still show considerable morbidity and mortality. In this article, the results of pioneers' attempts in hepatobiliary surgery for difficult hilar cholangiocarcinomas are reviewed. It is recommended that curative hepatobiliary resection should be performed for hilar cholangiocarcinoma, with careful preoperative management of patients complicated with several difficult conditions. Received for publication on June 5, 1997; accepted on July 25, 1997     

Surgical resection for hilar cholangiocarcinoma

A retrospective analysis of 62 patients who underwent resection for hilar cholangiocarcinoma performed between 1981–1994 was undertaken. Type I lesions and patients whose operations were performed less than 24 months prior to analysis were excluded, leaving a study cohort of 48 patients (27 male: 21 female, median age 66 years, range 23–86 years). Median post-operative stay was 20 days (8–60) with peri-operative mortality of 10.4%. Histopathological grading of paraffin sections of excised tumours was made, using standard criteria, into poor, moderate, and well differentiated lesions, and the three sub-groups were separately analysed. Patients with poorly differentiated lesions (n=16) had a median survival of 7 months (range 0–24), with 1-and 2-year survival of 19% and 0%, respectively. The median survival of patients with moderately differentiated tumours (n=20) was 27 months (range 0–84), with 1-, 2-, 3-, and 5-year survival of 70%, 55%, 35%, and 22%, respectively. Those with well differentiated carcinomas (n=12) fared better, with a median survival of 62 months (range 16–120) and 1-, 2-, 3-, and 5-year survival of 100%, 66%, 66%, and 58%, respectively. Differences in survival were highly significant atP<0.0001. Patients with poorly differentiated tumours would be best served by non-surgical intervention if this differentiation could be reliably made pre-operatively. Conversely, those with more favourable histological grading are potentially curable by an aggressive radical resection.     

手术切除治疗肝门部胆管癌

目的 总结肝门部胆管癌手术治疗的经验.方法 回顾性分析本院9年因肝门部胆管癌行手术切除的83例病人的临床资料和随访结果.结果 83例手术切除病人中行根治性切除（R0）31例,非根治切除52例（R1,R2）,术后出现并发症29例,死亡5例.根治性切除组中位生存期21.5个月,1、3、5年生存率分别为79.6%,43.3%和25.9%,明显优于非根治性切除组（P＜0.05），近5年本院根治性切除率达44.8%,中位生存期18.7个月,疗效明显提高（P＜0.05），结论 加强围手术期处理、术中行切缘冰冻病理检查、联合肝切除等可提高肝门部胆管癌根治性切除率、减少并发症和死亡率;根治性切除可更好延长病人生存期,使手术治疗肝门部胆管癌获得良好的疗效.     

联合肝叶切除治疗肝门部胆管癌

目的研究联合肝叶切除术治疗肝门部胆管癌的手术方式、并发症及疗效。方法回顾性分析2000年1月至2011年3月67例肝门部胆管癌患者临床资料。联合左半肝切除23例,右半肝切除9例,尾状叶切除3例,右三叶、右前叶切除各4例,姑息性切除15例,内引流术4例,经皮肝穿刺胆道引流外引流术5例。结果死亡1例,手术并发症发生率37．31％（25／67）。联合肝叶切除组术后中位生存时间为31．1个月,高于姑息性切除组（15．8个月）。联合肝叶切除组的1、3、5年存活率为78．5％、48．3％和29％,姑息性切除组的1、3、5年存活率为43．5％、6．8％、0。术后随访率67．16％（45／67）。结论肝门部胆管癌应积极手术切除治疗,对无明显手术禁忌证的患者行包括肿瘤切除的联合肝叶切除的扩大根治术可延长患者存活期;围手术期正确处理是减少术后并发症,提高患者生活质量和延长存活期的关键。     

肝门部胆管癌的外科治疗

肝门部胆管癌切除率低,预后差.近年来随着高分辨率影像学技术的应用、手术器械的改进、围手术期治疗策略的优化,特别是手术技巧的改进和经验的积累,使肝门部胆管癌切除率及根治率得到大幅度的提高.手术切除是治疗肝门部胆管癌的主要手段,根治性切除仍然是患者获得长期生存甚至治愈最重要的措施.本文回顾性分析2004年4月至2012年4月首都医科大学附属北京佑安医院收治的66例肝门部胆管癌患者的临床资料,探讨肝门部胆管癌外科治疗中的关键技术及相关预后.     

肝门部胆管癌的手术治疗

Despite recent advances in preoperative diagnostic imaging and operative techniques for hilar cholangio-carcinoma, postoperative mid-or long-term survival has not improved. Moreover, it remains difficult to achieve curative resection with a negative resection margin for complicated hilar cholangiocarcinoma of Bismuth type ⅢorⅣ. Although it is questionable whether hepatic artery resection can improve the prognosis, combined vascular resection of the portal vein and hepatic artery for treatment of the tumor extending along the bile duct may be one of the key factors to achieve a negative resection margin. Further investigation is required to determine whether radical resection of the remaining liver parenchyma and limiting the amount of resection as much as possible, as well as the no-touch isolation technique, can improve the prognosis of patients.