肝切除术加区域性淋巴结清扫治疗肝门部胆管癌

目的探讨肝切除术加区域性淋巴结清扫治疗肝门部胆管癌的疗效。方法回顾性分析1990年1月～2004年12月收治的60例肝门部胆管癌的根治性治疗资料。所有病人均给予肝外胆管切除及区域淋巴清扫。根据肝切除情况分为2组：肝切除组38例，未切肝组22例。结果肝切除组和未切肝组术后并发症发生率分别为31．58％、9．09％，两者有统计学差异（P〈0．05），两组病死率分别为5．26％、4．55％，无统计学差异（P〉0．05）。肝切除组1、2、3年累积生存率分别为84．2l％、60．53％、39．47％，未切肝组分别为72．73％、31．82％、13．64％，两组比较，第1年无差别（P〉0．05），第2、3年有统计学差异（P〈0．05）。结论肝切除术加区域性淋巴结清扫是提高肝门部胆管癌根治性切除率、生存率和改善生活质量的重要手段，骨骼化淋巴清扫应成为操作规范。

Hepatectomy with Regional Lymphadenectomy for Hilar Cholangiocarcinoma

Objective To assess the outcome of hepatectomy with regional lymphadenectomy for hilar cholangiocarcinoma. Methods The clinical data of 60 patients who underwent radical resection for hilar cholangiocarcinoma from January 1990 to December 2004 were analyzed retrospectively. All patients were divided into two groups: group A underwent hepatectomy (n=38) and group B did not receive hepatectomy (n=22). All patients underwent extrahepatic bile duct resection and regional lymphadenectomy. Results The postoperative morbidity and mortality in group A and B were 31.58% , 5.26% and 9.09%, 4.55% respectively. There was significant difference in terms of postoperative morbidity between two groups (P<0.05),but not in terms of mortality(P>0.05). The 1-,2- and 3-year overall survival rates in group A and group B were 84.21%,60.53%, 39.47% and 72.73%, 31.82%,13.64% respectively. There were significant difference in survival rates between two groups of the 2- and 3-year survival (P<0.05). Conclusions Hepatectomy with regional lymphadenectomy for hilar cholangiocarcinoma are critical to improve the survival. Skeletonization of the hepatoduodenal ligament should be comprised by any means in the procedure.