肝门部胆管癌的外科治疗

目的 探讨肝门部胆管癌的诊断方法和外科治疗方式。方法 总结和分析102例肝门部胆管癌患者的临床资料。结果 探查取活检术21例(20.6%),平均生存72d;外引流术18例(17.6%),平均生存8.3个月;手术切除加吻合术63例(61.8%),平均生存25.7个月。手术方式包括肝外胆管癌切除、肝方叶切除加肝外胆管癌切除、左半肝切除、尾叶切除加肝外胆管癌切除、肝内胆管一空肠Roux-Y吻合术等。结论 术中胆道切断端应行冰冻病理检查。治疗应以手术切除为主,根治性切除术可延长患者生存期和改善生存质量,效果比单纯外引流好,对不能切除病例应设法减轻黄疸。

Surgical treatments for hilar cholangiocarcinoma

Objective To explore the diagnosis and surgical treatment of hilar cholangiocarcinoma. Methods and Results Of 102 patients with hilar cholangiocarcinoma, 21 (20.6%) underwent surgical exploration and biopsy with an average survival time of 72 d, 18 (17.6%) received drainage with that of 8.3 months, and 63 (61.8%) were subjected to surgical resection and anastomosis with that of 25.7 months. The surgical approaches included resections of the perihepatic cholangiocarcinoma, of the quadrate lobe and outer bile ductule carcinoma, of the left half of the liver, of the caudal lobe and outer bile ductule carcinoma, and Roux-en-Y ligation of the intraheptic bile ductule-jeajunum. Conclusions Resection is a the primary choice for treatment of hilar cholangiocarcinoma, and radical resection may prolong the patients' survival time and achieve better effect than simple drainage. In cases where resection is impossible, jaundice management should be carried out.