手术与介入治疗晚期肝门部胆管癌的疗效比较

目的 比较晚期肝门部胆管癌手术与介入治疗的疗效。方法 回顾性分析2002年1月～2006年12月93例行手术或介入（PTCD或ERCP置入内撑支架）治疗Ⅲ-Ⅳ型肝门部胆管癌的临床资料。结果 介入与手术治疗的中位生存时间分别为9．5月和11．3月，两者总体生存曲线位置相似（P〉0．05）；手术组术后并发症肝功能衰竭2例，吻合漏3例，切口感染3例，平均住院时间为27d，平均住院费用超过5万元。而介入治疗组病入无腹部切口引起疼痛，亦无上述的术后并发症，平均住院时间为13．5天。平均住院费用为2万元左右。两组间在住院时间和住院费用有显著性差异（P〈0．01）。结论 微创介入方法治疗晚期肝门部胆管癌的生存时间与手术治疗相近。同时具有肝功能改善明显、并发症少、住院时间短、住院费用少。因此它可以成为姑息治疗的重要手段。

Comparison of the effect between surgical operation and interventional therapy for advanced hilar cholangiocarcinoma

Objective To compare the curative effect between surgical operation and interventional therapy for advanced hilar cholangiocarcinoma. Methods From January 2002 to December 2006,93 cases with type III～IV hilar cholangiocarcinoma received surgical operation and interventional therapy were analyzed retrospectively. Results The median survival time of interventional therapy group and surgical operation group were 9.5 and 11.3 monthrespectively, which as the survival curves were similar between the two groups （P 〉 0.05）. In the operative treatment group, main postoperative complications were as follows： hepatic failure 2 cases, anastomotic leakage 3 cases and wound infection 3 cases. Median hospitalization was 27 days and hospitalized cost was over fifty thousands RMB. In the interventional therapy group, no mentioned above complications were found and no abdominal incision induced pain. Median hospitalization was 13.5 days and hospitalized cost was twenty thousands RMB. There were significant difference in hospitalization time and cost between the two group （P 〈 0.01 ）. Conclusion Minimally invasive method is similar to operative treament in the survival time for the treatment of advanced hilar cholangiocarcinoma. At the same time, it has obvious improved liver function, few postoperative complications, shorter hospitalization and lower hospitalized cost. So it will become an important means of palliative treatment.