联合肝叶切除在肝门部胆管癌根治性切除术中的应用

目的探讨联合肝叶切除在肝门部胆管癌根治性切除术中的应用价值。方法总结河南省肿瘤医院自2005年6月至2008年10月以来同一手术组收治的67例肝门胆管癌切除病例的临床和随访资料。结果根据术中探查情况和Bismuth分型实施，其中38例行联合肝切除和29例未联合肝切除；肝切除组获R0根治21例，R0根治率55．3％，未行肝切除组获R0根治10例，R0根治率34．5％，R0根治率两组间差异有统计学意义（P=0．024）；肝切除组有15例出现并发症，发生率39．5％，其中肝肾功能衰竭死亡1例，未切肝组4例出现并发症，发生率为13．8％；R0根治组（31例）1、3、5年累积生存率分别为89．3％、53．6％和32．1％，R1-R2根治组1、3、5年累积生存率分别为69．7％、30％和10％，两组间术后生存率差异有统计学意义（P=0．018）；肝切除组1、3、5年累积生存率分别为81．8％、48．5％和24．2％，未肝切除组1、3、5年累积生存率分别为75％、32％和16％，肝切除组与未肝切除组的术后生存率差异有统计学意义（P=0．037）。结论肝门部胆管癌应积极外科治疗，联合肝叶切除可提高肝门部胆管癌的根治性切除率，延长患者生存期。

Combined hepatectomy in radical resection for hilar cholangiocarinoma

Objective To evaluate the value of combined hepatectomy in radical resection for hilar cholangiocarinoma. Methods The clinical data and follow-up data of 67 patients of resection for hilar cholangiocarinoma in Henan Tumor Hospital from June 2005 to october 2008 were retrospectively analyzed. Results According to intraoperative exploration situation and bismuth types, tumor resection was combined performed with hepatectomy (n＝38)or non-hepatectomy (n＝29). The rate of R0 resection was 55.3% in hepatectomy group(n＝21) and 34.5% in non-hepatectomy group(n＝10), and the difference was significant（P＝0.024）. The incidence of complications were 39.5% in hepatectomy group(n＝15) and 13.4% in non-hepatectomy group(n＝4), and one patient with liver and kidney failure died in hospital. The 1, 3, 5 years of survival rate were 89.3%,53.6% and 32.1% respectively in R0 group (n＝31) and 69.7%,30% and 10% respectively in R1～R2 group(n＝36), there were significant differences in the postoperative survival rate between both groups（P＝0.018). The 1, 3, 5 years of survival rate were 81.8%,48.5% and 24.2% in hepatectomy group and 75%,32% and 16% in non-hepatectomy group respectively, and the differences were significant（P＝0.037). Conclusions Aggressive resection including combined hepatectomy for hilar cholangiocarcinoma can play an important role for curative effect and long term survival rate.