肝门部胆管癌的外科治疗(附181例报告)

目的　探讨肝门部胆管癌预后与临床病理因素的关系。方法　总结１９７８ 年至１９９７ 年手术治疗１８１ 例肝门部胆管癌的临床病理资料，以１９９１ 年为界分为两个阶段，对比手术切除率及生存期等。结果　１８１ 例中手术切除９７ 例，非切除性胆道内外引流者８４ 例，切除组中根治切除５１ 例，姑息切除４６ 例。根治切除者１、３ 、５ 年生存率分别为９５％ 、２７－５％ 和１７－５％ 。姑息切除者为４８－１％ 、７－４％ 和３－７％ ，非切除性胆道内外引流者１ 年生存率分别为４８％ 、３８－９ ％ ，无２ 年生存者。两阶段对比显示：手术切除率由４０－４％ 提高到６６－３ ％ ，其中根治切除率由１８％ 提高到３８％ 。结论　根治切除是提高肝门部胆管癌远期生存率及改善生活质量的关键，早期肿瘤，分化程度好，无淋巴转移者预后好。

Surgical treatment for hilar cholangiocarcinoma:a report of 181 cases.

Objective To define the relationship between prognosis and clinico pathological factors in patients with hilar cholangiocarcinoma. Methods Clinico pathological data of 181 patients with hilar cholangiocarcinoma treated surgically in our center from 1977 to 1997 were analysed retrospectively. The resection rate and survival time of the patients before 1991 were compared with those after 1991. Results Of the 181 patients, 97 underwent resection (radical resection, 51; palliative resection, 46) and 84 were subjected to nonresectional internal or external drainage. In the resection group, the 1,3,5 year survival rates were 95%, 27.5%, 17.5% and 48.4%, 6.5%, 4.0% in radical and palliative resection subgroups, respectively, whereas in the nonresection group, the 1 year survival rate was 48% in internal and 38.9% in external drainage subgroups. None in the patients of the nonresection group survived for over 2 years. Comparison between the two periods revealed that the resection rate has been increased from 40.4% to 66.3% and the radical resection rate from 18% to 38%. Conclusion Favorable outcome after resection can be obtained in patients with cancer of early stage, well differentiation and absence of lymph node metastases.