外科治疗肝门部胆管癌68例临床分析

目的：探讨提高肝门部胆管癌尤其是肝门部血管受肿瘤侵犯病例的外科治疗方法。方法：回顾性分析我院1986年1月～2004年12月收治手术的肝门部胆管癌68例。结果：按Bismuth-Corlette分型法：Ⅰ型7例,Ⅱ型15例,ⅢA型19例,ⅢB型12例,Ⅳ型15例（包括不能分型3例）。26例（38.24%）确诊前曾有胆囊结石和/或肝内外胆管结石手术史,或同时合并有胆石症。B超、CT和MRCP的确诊率分别为71.43%、84.00%和91.43%。手术方式：根治性切除24例,姑息性切除14例,胆道引流30例。术后1、2、3年生存率：根治性切除组分别为85.0%（17/20）、60.0%（12/20）和25.0%（5/20）,其中3例生存时间超过5年;姑息性切除组分别为58.3%（7/12）、25.0%（3/12）和0,两组之间的3年生存率比较有显著性差异（P〈0.05）;胆道引流组1、2、3年生存率分别为21.4%（6/28）、10.7%（3/28）和0。结论：积极提高手术切除率是改善肝门部胆管癌预后的惟一有效方法;肝十二指肠韧带骨髂化、肝部分切除可提高根治性切除率。姑息性切除、胆道引流有助于改善患者生活质量,延长生存。

The surgical treatment of hilar cholangiocarcinoma and dealing with the vascular problem

Objective：To explore how to increase the radical resection rate of hilar cholangiocarcinoma and invasion blood tube.Methods：Between 1986 and 2004,68 patients with hilar cholangiocarcinoma having surgery treatment were reviewed retrospectively.Results：According to the Bismuth-Corlette staging system,there were type Ⅰ 7 cases,type Ⅱ 15 cases,type ⅢA 19 cases,type ⅢB 12 cases,type Ⅳ 12 cases and unclassifiable 3 cases.Twenty-six（38.24%）patients had the history of operation for cholelithiasis or with cholelithiasis simultaneously.The rate of diagnosis of B type ultrasound,CT and MRCP was 71.43%,84% and 91.43%,respectively.Of the 68 patients,24（28.57%）underwent radical resection,14（16.67%）underwent palliative resection and 30（35.71%）received internal or external drainage.The rate of radical resection was 24/68（35.29%）.The 1,3 and 5-year survival rates was 85.0%,60.0%,25.0% in the radical resection group and 58.3%,25.0%,0 in the palliative resection group respectively,there was a remarkable difference between them.Three patients had survived for more than 5 years in the radical resection group.The 1,3 and 5-year survival rates was 21.4%,10.7%,0 in the drainage group.Conclusion：It is very important factor to improving the prognosis of hilar cholangiocarcinoma how to increase the radical resection rate,and the combination procedure of skeletonization of hepatoduodenal ligament,partial liver resection and the excision and reconstruction of invaded hilar blood vessels may raise the radical resection rate.