肝门部胆管癌手术治疗的再认识(附45例分析)  

Radical resection of hilar cholangiocarcinoma: a report of 45 cases

作　　者：吴飞跃[1] 欧阳永忠[1] 莫胜川[1] 

机构地区：[1]湖南省肿瘤医院腹外二科,长沙市410006

出　　处：《中华肝胆外科杂志》2006年第12期829-831,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨肝门部胆管癌的诊断及根治性切除方法。方法回顾性分析45例肝门部胆管癌的临床特点、根治性切除方法及治疗效果。结果本组术前均明确诊断。根治性切除45例,手术死亡5例(11．1％),胆漏5例(11．1％),其中2例并膈下脓肿,均经引流或再次手术引流治愈,右胸腔积液4例(8．9％),均经保守治疗治愈,切口裂开3例(6．7％),经再次缝合治愈。本组45例中,有36例(90．0％)获得随访,1,3年生存率,分别为91．7％,36．1％,无5年生存者。结论肝门部胆管癌早期诊断困难,联合应用影像学检查可明确诊断。本组根治性切除率仍较低,术后易复发和转移,鲜有长期生存者,手术死亡率仍较高。说明手术切除和清扫范围不够,手术技术有待进一步改进。Objective To investigate the diagnosis and radical resection of hilar cholangiocarcinoma. Methods The clinical data of 45 patients with hilar cholangiocarcinoma receiving radical resection in our hospital were retrospectively analyzed. Results The diagnosis was achieved in all the patients preoperatively and radical resection was performed in all of them. Five patients （11.1 %） had died after the operation. Five patients （11.1 %） had bile leakage, and 2 of them developed subphrenic abscess. The 2 were cured by drainage. Four （8. 9%） had right hydrothorax and cured by conservative methods. Three （6. 7%） had incision split and cured by resuturing. The follow-up in 36 patients showed that the 1- and 3-year survival rates were 91.7% and 36.1%, respectively. None of the patients has survived for over 5 years. Conclusions It is still difficult to get early diagnosis of the hilar cholangiocarcinoma and its diagnosis is mainly depended on combined imaging techniques. Nowadays the radical resection rate is still low and the recurrence and metastasis are common after operation. Only a few patients can survive for a long time. The postoperative mortality is high. Therefore, the operative procedure should be further improved.

关 键 词：胆管肿瘤 肝管 总/外科学 腺癌 

分 类 号：R735.8[医药卫生—肿瘤]