肝门部胆管癌165例的诊断与外科治疗

目的 总结肝门部胆管癌的诊断及外科治疗.方法 回顾性分析1972-2001年收治的肝门部胆管癌165例的临床资料.结果 根据不同时期的发病例数、手术切除率不同,分为前15年第一阶段及后15年的第二阶段.首发症状为上腹不适或闷痛、胀痛、乏力、食欲减退及进行性黄疸.B超、CT、MRI和MRCP是无损伤诊断的首选方法;若显示肝内胆管扩张或诊断肝外梗阻性黄疸,则应行PTC（27例）、MRCP（15例）或ERCP（78例）.本组手术切除73例,切除率44.2%,其中根治性切除38例;非根治性切除35例.第一阶段切除15例,切除率27.3%;第二阶段切除58例,切除率52.7%.本组54例得到随访,其中根治性切除术5年生存率39.5%,非根治性切除术为14.3%;未切除的62例得到随访,均于1～1.5年死亡.结论 一旦诊断为肝门部胆管癌,就应积极剖腹探查,不要延误切除时机.手术切除是治疗肝门部胆管癌的最有效的治疗方法.

Diagnosis and surgical treatment of 165 cases of hepatic hilar cholangiocarcinoma

Objective To summarize the experience in diagnosis and surgical treatment of hepatic hilar cholangiocarcinoma. Methods The clinical data of 165 patients with hepatic hilar cholangiocarcinoma receiving surgical treatment in our hospital from 1972 to 2001 were retrospectively analyzed. Methods The 165 patients were included in the first stage of former 15 years and the second stage of latter 15 years according to the incidence and surgical resection rate. The primary symptoms were upper abdominal malaise, gas pain, inertia, appetite decline, weight loss and progressive jaundice. Bmode uhrasonography, CT, MRI and MRCP were the good methods for atraumatic diagnosis. If the patients displayed the intrahepatic bile duct dilatation or were diagnosed to suffer from extrahepatic obstructive jaundice, the PTC, MRCP or ERCP should be employed. Seventy-three patients underwent surgical resection and the resection rate was 44. 2 %. Of these 73 patients, 38 received radical resection and 35 non-radical resection. Fifteen patients underwent resection in the first stage and 58 did it in the second stage. A total of 54 patients were followed up after the resection. The 5-year survival rate was 39.5%0 and 14.3%0 in radical resection group and non-radical group, respectively. The follow-up in other 62 patients not receiving the resection showed that they died in 1-1.5 years. Conclusions Once the patients are diagnosed to suffer from hepatic hilar cholangiocarcinoma, they should undergo exploratory laparotomy. Surgical resection is the most effective method for treatment of hepatic hilar cholangiocarcinoma.