肝门部胆管癌54例临床分析

目的 分析54例肝门部胆管癌的诊断和治疗方法。方法 肝门部胆管癌无临床特异性，采取B-US-CT-ERCP-MRCP或PTC(PTCD)；CEA或CA19-9，有助于诊断。肝门部胆管癌切除者行高位胆肠ROUX-EN-Y吻合术。未切除者行胆汁内或外引流术，或行PTCD。结果 共有17例予以切除，11例切除后生存在18个月以上。切除17例术后血清胆红素均降至正常水平。结论 肝门部胆管癌外科手术治疗是主要手段。根治性切除的原则是：两切断端无癌残留。肝内无转移，无淋巴结转移。影响预后的因素主要是：手术方式。根治性手术大于非根治性手术；侵犯胰腺周围神经组织是第一、二位重要因素，而年龄、性别、肿瘤大小、大体类型等与预后无重要关系。

Clinical analysis of hilar cholangiocarcinoma in 54 cases

To analyze the diagnosis and treatment methods of hilar cholangiocarcinoma in 54 cases. Hilar cholangiocarcinoma has no specificity in clinical manifestation. It was helpful to diagnosis by B-US-CT-ERCP-MRCP or PTC( PTCD) and CEA or CA19-9. We performed cholangiojejunostomy on the patients who underwent excision of the tumor. There were total 17 cases who underwent excision, among those 11 patients have survived over 18 months. Hemobilirubins of all the patients who underwent excision have decreased to normal level after the resection. Conclusions] Operation is the main treatment. The principle of the radical operation is that there is no cancer cell in two stumps, no lymphatic metastasis, no liver metastasis. There are two prognosis factors. One is the way of operation, radical operation is superior to non-radical operation. The other is whether pancreas and peripheral nervous system are invaded. Age, sex, morphology and the size of the tumor are not vital factors to prognosis.