肝外胆管癌的外科及综合治疗  

Surgical and comprehensive treatment of extrahepatic cholangioearcinoma

作　　者：谈景旺[1] 陈文[1] 吴燕斌[1] 王君[1] 张伟平[1] 季洪兵[2] 

机构地区：[1]福建省第二人民医院普通外科,福州市350003 [2]福州总医院

出　　处：《中华肝胆外科杂志》2007年第1期28-31,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨提高胆管癌治疗效果的有效方法。方法回顾分析1998年3月至2004年10月间我们收治78例胆管癌病人的外科治疗及部分病人配合化疗、放射、免疫等治疗的疗效。结果胆管癌切除率占60．3％，其中切缘阴性根治切除术占35％。手术切除的18例肝脏标本中，肝组织侵犯达11例（60％）。切缘阴性骨骼化根治切除术组1年、2年、3年存活率分别为75．7％、51．5％和32．6％，姑息性切除组分别为38％、10％和0。直接胆肠吻合术或内镜下放置胆管支架内引流组，术后生存2～11个月，平均生存时间为（6±2．8）个月，手术或仅经皮肝穿刺行外引流组，生存时间为1～5个月，平均生存时间为（3．6±1．8）个月。经过上述治疗后，4例为内引流全身化疗病人，平均生存时间为（7．5±2．2）个月，无显著效果；5例为内引流行区域性化疗病人平均生存时间为（11±4．3）个月，较相应无区域化疗者（6±2．8个月）明显延长（P〈0．001）。内引流术后伽玛射线放射治疗11例平均生存时间为（11．7±3．1）个月，较相应无伽玛射线放射治疗者（6±2．8个月）明显延长（P〈0．001）。结论肝外胆管癌治疗效果尚不理想，提高肝外胆管癌根治性切除是提高疗效重要途径之一，但必须选择好扩大根治的适应证。对于无法根治切除者，配合局部区域化疗及三维适形为基础的定位放疗也能起到一定延长生命作用，值得进一步探讨。Objective To determine effective methods for treatment of extrahepatic cholangiocarcinoma. Methods The clinical data of 78 patients with extrahepatic cholangiocarcinoma receiving surgical and other treatments from March 1998 to October 2004 in our hospital were retrospectively analyzed. Results The resection rate was 60. 3% and the rate of negative residual tumors at resection margin 35%. The biopsy indicated that 11 livers （60%） were involved by tumor in 18 patients receiving hepatectomy. The 1-, 2- and 3-year survival rates were 75.7%, 51.5% and 32. 6% in radical resection group and 38%, 10% and 0 in the palliative resection group, respectively. The average surviving time was 6±2. 8 months （2-11 months） and 3.6±1.8 months （1-5 months） in the internal drainage group and external drainage group, respectively. Four patients receiving chemotherapy after internal drainage had a survival time of 7. 5 ±2. 2 months, which was similar to that in the contrast group. Five patients undergoing local chemotherapy had a survival time of 11±4. 3 months, indicating a significant delay （P,0. 001）. Eleven patients receiving CT-guided radiotherapy with ？ radiation after internal drainage had a survival time of 11.7±3. 1 months, indicting a remarkable prolongation （P〈 0. 001）. Conclusions The outcome of treatment for extrahepatic cholangiocarcinoma is still not satisfactory. Improvement of radical resection rate is important for its treatment.

关 键 词：胆管肿瘤 治疗 手术 区域性化疗 放射治疗 

分 类 号：R686[医药卫生—骨科学]