肝门部胆管癌192例外科治疗及疗效分析

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 对１９８４年至１９９９年收治的１９２例肝门部胆管癌的临床特点，诊断，手术方式和随访结果进行回顾分析。结果 本组ＭＲＣＰ对肝门部肿物显示率１００％（４４／４４）。１５３例行手术治疗，其中探查术１０例，内、外引流术８８例，均于术后３－１５个月死亡。切除术５３例，全肝切除原位肝移植术２例。手术切除率为３６.０％（５５／１５３），行根治性切除３８例，中位生存期为３１个月，姑息性切除１７例，中位生存期为１３个月。结论 ＭＲＣＰ可以确定肝门部胆管癌病变部位及范围。术中胆道切断端应行冰冻病理检查。经根治切除术可显著延长患者生存期和改善生存质量。对于ＢismuthⅢ型、Ⅳ型无肝外转移者，行全肝切除、肝移植术不失为一种有效的治疗方法。

Surgical treatment of hilar cholangiocarcinoma: report of 192 cases

Objective　 To evaluate the diagnostic method for and surgical effect on hilar cholangiocarcinoma. 　 Methods　 The clinical features, diagnosis, surgical therapy and long-term result were retrospectively analysed on 192 cases of hilar cholangiocarcinoma admitted into our hospital from Jan.1984 to Jun.1999.　 Results MRCP delineated 100%(44/44) of the hilar tumors. 153 cases underwent exploration. 88 cases treated by internal or external drainage have survived for 3～15 months. Tumor resection was performed on 53 cases, and orthotopic liver transplantation on 2 cases, with a resection rate of 36%(55/153) including radical resection in 38 cases (median survival period was 31 months). 17 cases undergoing palliative resection have a median survival period of 13 months. 　 Conclusion　 MRCP was an ideal noninvasive preoperative examination for identifying hilar cholangiocarcinoma. Routine frozen section of the bile duct margin should be adopted. Radical resection definitely prolongs survival period. For Bismuth type Ⅲ、Ⅳ without extrahepatic metastasis, orthotopic liver transplantation was an effective surgical therapy.