肝门部胆管癌的外科对策

目的 总结肝门部胆管癌的诊治经验.方法 回顾性分析34例肝门部胆管癌的诊断,并提出相应外科治疗的对策.结果 34例中,除3例行经皮经肝胆管引流术/内镜逆行胰胆管造影术（PTCD/ERCP）外,余31例均剖腹探查,其中切除术12例,外科胆道旁路退黄术15例,胆道内置管引流术4例.剖腹的31例中,近期死亡3例,其中切除术2例.31例出院者中,有23例获随访,生存期最长6年,系根治性术后;而姑息性手术生存期最长为11个月.结论 对肝门部胆管癌的治疗,首选手术切除,次选退黄术,仅一些极晚期病例,方采用非手术治疗.

Surgical strategies for hilar bile duct cancer

Objective To sum up the experiences in diagnosing and treating patients with hilar bile duct cancer. Methods The diagnoses of 34 cases of hilar bile duct cancer were studied retrospectively, with the surgical strategies commented. Restilts Out of the 34 cases, 3 were treated by routine VIED/ERCP, and 31 by exploratory laparotomy. In the 31 cases, resection was performed in 12 cases, surgical bihary bypass for abatement of jaundice in 15 cases, and tube drainage of the bihary tract in 4 cases. There were 3 immediate deaths in the laparotomized patients, of whome 2 had undergone liver resection. 23 of the discharged patients were followed up, with the longest survival after radical operation being 6 years, and that after palliative treatment being 11 months. Conclusion In the cases of hilar bile duct cancer, resection is the first choice, while surgical biliary bypass for abatement of jaundice is the second and nonoperative treatment is left only to the much advanced cases.