肝外胆管癌的诊治

目的 总结肝外胆管癌的诊断及手术治疗方法。方法 回顾性分析1972年－1999年收治肝外胆管癌100例的临床资料，其中上、中、下及全段胆管癌分别为68，12，18及2例。结果 首发症状为上腹不适隐痛、腹胀、乏力，明显消瘦及进行性黄疸等。B超、CT或MRI是无损伤的诊断方法，若显示肝内胆管扩张或诊断肝外梗阻性黄疸，则应进一步行PCT（本组13例）或ERCP（本组42例）。根据肿瘤所在部位及肝门部胆管癌的分型，选择不同的手术方式：上段手术切除25例（36．8％），其中Ⅰ型行胆管癌局部或“骨骼化”切除15例，Ⅱ型行胆管癌切除加尾叶切除9例，Ⅲb型行胆管癌切除加尾叶及左三叶切除1例；中段手术切除9例（75％）；下段行胰十二指肠切除14例（77．8％）。上、中段均行胆管空肠Roux-en-Y型吻合胆道重建术。本组总切除率为48％。有35例得到随访，5年生存率为58％。未切除者52例中有32例得到随访，均于1－1．5年死亡。结论 B超、CT及MRI是早期诊断肝外胆管癌的首选方法，必要时选用PTC或ERCP对进一步诊断更有价值。手术切除是治疗肝外胆管癌最有效的手段。

Diagnosis and treatment of the extrahepatic bile ducts carcinoma

Objective　To summarize the methods of diagnosis and operation of carcinoma of the extrahepatic bile ducts. Methods　The clinical data of 100 cases of carcinoma of the extrahepatic bile ducts which were treated in our hospital from 1972 to 1999 were retrospectively analysed. In this series, there were 68 cases of the cancer located in the upper portion of exlrahepatic duct(proximal cancer), 12 in midder portion(midder cancer), 18 in lower portion(distal cancer), and 2 in whole bile duct. Results　The initial symptom was upper abdominal discomfort or vague pain, abdominal distension, weakness, weight loss and progressive jaundice. BUS, CT and MRI were scatheless. If the intrahepatic bile duct dilatation or extrahepatic cholestatic jaundice were revealed, PTC(13 cases in this series) or ERCP(42 cases in this series) were to further determine the location of tumor. According to the position and type of the tumor, the different operations were selected. Twenty-five cases(36.8%) of the proximal cancer were resected, including 15 cases of type Ⅰ treated with localresection or “skeletonization” resection, 9 cases of type Ⅱ treated with resection of the tumor and caudate lobe, 1 case of type Ⅲb treated with resection of the tumor, caudate lobe and left hepatic trisegmentectomy. Nine cases(75%) of midder cancer were resected. After resected the proximal and midder cancer, bile duct reconstruction by Roux-en-Y hepaticojejunostomy was performed on all the cases. Fourteen cases(77.8%) of distal cancer were treated by pancreatoduodenectomy. The total resection rate in this series was 48%. Of the cancer resected cases, 35 were followed up, the five-year survival rate was 58%. 32 of the 52 cases without cancer resection were followed up, and all of them died one to one and half year after operation. Conclusions　BUS, CT and MRI are the first selective methods for early diagnosis of the carcinomas of extrahepatic bile duct. If needed, PTC or ERCP should be done because of these methods have more accurate diagnostic value. Surgical resection of the tumor is the only likelihood for effective treatment.