胆道恶性肿瘤的外科治疗(附15年临床分析)  

The evaluation of surgical approach for biliary duct carcinomas(A report of 15 years clinical datas)

作　　者：施乾锋[1] 梁廷波[1] 罗卫庆[1] 郑树森[1] 秦运升[1] 王伟林[1] 张珉[1] 沈岩[1] 

机构地区：[1]浙江大学医学院附属第一医院肝胆胰外科,杭州310031

出　　处：《江西医药》2007年第5期391-394,共4页Jiangxi Medical Journal

摘　　要：目的评价胆道恶性肿瘤外科治疗的价值。方法对1990年1月￣2005年12月收治的资料完整的260例胆道恶性肿瘤(胆囊癌125例,胆管癌135例)的临床资料进行分析。结果125例胆囊癌手术切除率为84.16%(85/101),其中根治性切除率为42.57%(43/101);135例胆管癌手术切除率为70.75%(75/106),其中根治性切除率为56.60%(60/106)。胆囊癌的总体5年生存率为10.96%,胆管癌的总体5年生存率为18.75%,两者根治性切除组的5年生存率分别为28.82%和41.27%,与姑息性切除组、姑息引流活检组、未手术组相比有显著性差异(P<0.05);姑息性切除组与未手术组相比有显著性差异(P<0.05),但与姑息引流活检组相比,仅在胆管癌有显著性差异(P<0.05),在胆囊癌两者间无显著差异(P<0.05);姑息引流活检组与未手术组相比无显著性差异(P<0.05)。多因素分析显示组织学分级,TNM分期及治疗方法与预后显著相关。结论胆道恶性肿瘤的远期疗效仍令人失望,根治性切除仍是提高远期生存率的主要手段。Objective To explore the value of surgical approach for bitiary duct carcinomas.Methods The clinical datas of 260 patients with biliary duct carcinoma （included gallbladder carcinoma 125 cases and extrahepatic duct carcinoma 135 cases）,which were admitted to our hospital from January i990 to December 2005 were analyzed retrospectively.Results The total resection rates and radical resection rates were 84.16% （85/101）,42.57% （43/101）and70.75% （75/106）,56.60% （60/106）iu gallbladder carcinoma and extra＇ hepatic duct carcinoma, respectively.The overall 1,3,5-year survival rates were 35.58%, 18.02%, 10.96%and46.93%,37.33%, 18.75% in gallbladder carcinoma patients and extrahepatic duct carcinoma patients, respectively.ln radical resection group, 1,3,5-year survival rates were 74.76% ,36.60% ,28.82% and 74.94% ,55.74% ,41.27% in gallbladder carcinoma patients and extrahepatic duct carcinoma patients, respectively, and these results were better than that of palliative resection groups statistically （P〈0.05）.The survival rates of patients with palliative resection were remarkably higher than that of patients with palliative drainage or without operationfor extrahepatic duct carcinoma（P〈0.05）.For gallbladder carcinoma, the patients with palliative resection also survived longer than that of without operation （P〈O.05）,but they were no significant differences between palliative resection and palliative drainage （P〈 0.05）.Both of gallbladder carcinoma and extrahepatic duet carcinoma , the survival rates were no significant differences between palliative drainage and without operation （P〈0.05）.Muhivariate analysis revealed that the histopathological grades,TNM stages and modalities were key factors on the outcome.Conclusion The outcome of the patients with biliary carcinoma is still not optimistic.Radical resection is the first choice for tumors treatment.

关 键 词：胆囊癌 胆管癌 手术 预后 

分 类 号：R735.8[医药卫生—肿瘤]