肝门部胆管癌的诊治：附96例报告

目的:探讨肝门部胆管癌的治疗方法和效果。方法:回顾性分析12年余收治的96例肝门部胆管癌的临床资料，其中手术65例（R0 28例，R1 2例，R2 4例，胆道引流术31例），介入引流31例（PTCD 5例，胆道支架置放术26例），切除术后联合治疗33例（放射治疗18例，经肝动脉灌注化疗15例）。结果:术后生存的95例中获得随访88例，随访率为92.6%，平均随访时间26（2~99）个月。(1)根治性切除组、姑息性切除组、手术引流组、介入引流组的平均生存时间分别为25，15.5，11.5，11个月，根治性切除组优于姑息性切除组（t=8.70,P＜0.01），姑息性切除组优于手术引流组（t=4.31,P＜0.01），介入引流组与手术引流组相似（t=1.31，P＞0.05）。(2)R0 切除联合放化疗组平均生存期为27个月，1，3，5年生存率分别为75%，45%，15%；R0未联合放化疗组平均生存期为24个月，1，3，5年生存率为50%，12.5%，0,两组疗效有显著性差异（t=2.37，P＜0.05； χ=3.88，P=0.049）。(3)胆红素≥400 μmol/L的患者其并发症发生率明显高于胆红素＜400 μmol/L者（P＜0.05）。结论:根治性切除是治疗肝门部胆管癌最有效的方法。手术引流和介入引流治疗效果相似，但介入治疗创伤小，恢复快。当总胆红素≥400 μmol/L时，手术前应作减黄处理。手术切除联合放疗、介入化疗，可以提高疗效。

Diagnosis and Treatment of hilar cholangiocarcinoma: a report of 96 cases

Abstract:Objective:To summarize the experience of treatment of hilar cholangiocarcinoma. Methods :The clinical data and long-term outcome of 96 cases of hilar cholangiocarcinoma were analyzed retrospectively.Results:Out of 96 cases, 65 patients underwent surgical procedures (28 cases of radical resection,6 cases of palliative resection,31 cases of surgical drainage); 31 cases underwent inteventional drainage therapy, of them 18 cases had combined radiotherapy, and 15 cases and combined interventional chemotherapy. (1) The average survival time of the radical resection group, the palliative resection group and the surgical drainage group was 25 months, 15.5 months, and 11.5 months, respectively. There was a significant difference between the three groups (P＜0.01). (2) For the surgical drainage group, the average survival time was 11.5 months, which was not significantly greater than that of the interventional therapy group (11 months) (P＞0.05). (3) For the group of radical resection plus radiotherapy or chemotherapy, the average survival time was 27 months and 1-,3-,5-year survival rate was 75%,45%, and 15%, respectively, which was significantly greater than the group of radical resection without adding radio-therapy or chemotherapy (24 months, and 50%,12.5%,0, respectively) (P＜0.05).Conclusions:The best prognosis can be achieved by radical excision for patient with hepatic hilar cholangiocarcinoma. There is similar effect between the surgical drainage and interventional therapy, but the method of interventional therapy is safer with less injury and is convenient with few complications. Postoperative chemotherapy and radiotherapy may help to extend patient’s survival time.