肝门部胆管癌的诊断与手术治疗

目的本文探讨肝门部胆管癌的早期诊断方法,以提高手术切除率。方法回顾分析2005～2011年收治肝门部胆管癌30例的临床病例资料。结果术前确诊26/30（86.67%）。手术切除16例（53.33%）,其中根治性切除（R0切除）10例（33.33%）、姑息性切除6例（20%）,引流术12例（40%）,单纯剖腹探查术2例（6.67%）。术后随访28例,2人失访,随访率92.86%（26/28）,其中随访根治性切除10例,1、3、5年生存率分别为70%、50%、20%。随访姑息性切除6例,1、3年各1例,4例于一年内死亡。随访引流术10例全部于半年内死亡。结论肝门部胆管癌早期诊断困难,根治性切除率低,影像学检查可提高早期诊断率,对黄疸病人应尽早行影像学等相关检查,以提高根治切除率。手术是肝门部胆管癌的首选治疗。

Diagnosis and surgical treatment of hilar cholangiocarcinoma

Objective To discuss the early diagnosis of hilar cholangiocarcinoma and improve the successful resection rate.Methods The 30 hilar cholangiocarcinoma cases surgically treated from 2005 to 2011 were retrospectively analyzed.Results The preoperative diagnosis rate was 86.67%（26/30）,16 cases were surgical treated（53.33%）,10 cases were radical resected（33.33%）,6 cases were palliatively resected（20%）,12 cases were treated with drainage（40%）,simple laparotomy was given to 2 cases（6.67%）.There 28 cases were followed up and 2 lost with follow-up rate of 92.86%（26/28）,including 10 radical resection cases.The one,three and five-year survival rates were 70%,50%,20%.Six palliative resection cases were also followed up,1 case survived a year and one survived 3 years,the other 4 patients died within one year.All the 10 cases treated with drainage all died within six months.Conclusion Early diagnosis of hilar cholangiocarcinoma is difficult and radical resection rate was low.Imaging may improve early diagnostic rate,especially to jaundice cases and surgical treatment is the method of chice for treatment of hilar cholangiocarcinoma patients.