肝门部胆管癌的治疗  

Therapy of hilar bile duct cancer

作　　者：李威[1] 陈广灿[1] 曾永明[1] 陈君填[1] 郭毓文[1] 章斐然[1] 吴宝安[1] 王懿儒[1] 

机构地区：[1]汕头大学医学院第一附属医院普外科,广东汕头515041

出　　处：《中国现代医学杂志》2004年第21期75-78,共4页China Journal of Modern Medicine

基　　金：广东省科技计划项目资助(No:1997-77)

摘　　要：目的评价外科治疗肝门部胆管癌(hilarbileductcancer,HBDC)的疗效。方法回顾性分析该科自1989年11月~1999年8月共收治HBDC31例。其中,行单纯胆肠内引流术共18例(组1),行支撑内引流加内外放疗共9例(组2),行网络化切除加支撑内引流与网络化切除加支撑内引流加内外放疗共4例(组3)。结果随访的结果表明:术后生存期为1周~10.5个月(组1),在组2中,除外2例无法完成放疗,其他7例术后生存期平均为21.2个月,在组3中,由于病例太少无法做相对可靠的分析,但疗效显著。(其中1例患者术后存活达8年零7个月)。3组病例中,严重的并发症包括胃肠道出血2例,肝肾综合征1例,肺炎1例(76岁),发热6例。结论肝门部胆管癌(HBDC)由于其部位特殊和早期诊断困难,手术切除率低而预后较差。在无法行手术切除的病例中,单纯胆肠内引流术能有效地缓解病情,对于合适的病例,内引流联合内外放疗是安全的,有效缓解病情且能取得显著疗效。Objective:To evaluate the therapeutic effects of treatments for hilar bile duct cancer(HBDC).Methods:From November1989to August1999,31patients with hilar bile duct cancer were submitted to various surgical treat-ments:Simple bile duct drainage for18cases(GroupⅠ),stenting tube for internal drainage plus intra and extra radio-therapy for9cases(GroupⅡ),and skeletonization resection with stenting tube and/or additional intra and extra radio-therapy for4cases(GroupⅢ).Results:The followed up showed that postoperative survivals ranged from1week to10.5months in GroupⅠ.In GroupⅡ,except for2patients who couldn't finish the radiotherapy,the other7cases' survival periods were21.2months in average.In GroupⅢ,although the number of case was too small to make a relatively reli-able analysis,the outcome was excellent.One patient survival periods was8years and7mouths postoperative).The se-vere complications of this series were gastrointestinal hemorrhage(2cases),hepatorenal syndrome(1case),pneumonia(1case,76years old)and fever(6cases).Conclusion:HBDC is a kind of disease with a poor prognosis because of its spe-cial location and difficulty in diagnosing in early stages.The curative resection rate is very low.In unresectable cases,biliary drainage offers effective palliation.Internal biliary drainage combined with intra and extra radiotherapy,appears to be safe and effective for palliation of suitable cases and can achieve an even greater improvement in outcome.

关 键 词：肝门部胆管癌 切除术或内引流术 ^192Ir内放疗 ^60Co外放疗 联合放疗 

分 类 号：R735.8[医药卫生—肿瘤]