肝外胆管癌的外科治疗与预后关系临床探讨  

Treatment and Prognosis of Extrahepatic Choledochal Carcinoma

作　　者：范跃祖[1] 蔡同年[1] 王宝昌[1] 

机构地区：[1]上海铁道大学附属甘泉医院肝胆外科,上海市200065

出　　处：《中国肿瘤临床》1997年第3期189-192,共4页Chinese Journal of Clinical Oncology

摘　　要：作者对55例肝外胆管癌的治疗方法与预后的关系进行临床探讨。按Longmire分型，上段、中段、下段胆管癌分别占43．6％、21．8％、346％；有42例得到病理诊断。手术切除11例（26．2％），“减黄”手术30例（胆肠内引流14例，外引流16例），单纯剖腹，PTCD、非手术保守治疗分别为1、6、7例。随访1～62个月，随访率87．3％。平均生存时间10．8±9．7个月；手术切除组生存时间最长（21．4±16．7个月，P＜0．01），生存率最高（P＜005）；胆肠内引流组的生存时间（12．2±6．8个月）和生存率亦明显高于其它各组（P＜0．05）。因此，对有条件的肝外胆管癌，应争取早期作根治性切除＋胆管空肠吻合，并酌情切除受累肝脏；即使无根治条件，亦应尽可能作胆肠内引流。The therapeutic result of a total of 55 patients with extrahepatic choledochal carcinoma are evaluated. Of these patients, 24 patients had involvement of upper third of the common duct, 12 the mid-third and 19 the lower third. A diagnosis of common bile duct cancer was confirmed histopathologically in 42 patients with adenocarcinoma predominating. Of the 42 patients who underwent laparatomy 11 (26. 2 % ) had their tumor removed, 30 recieved palliative procedures (14 choledo-cho-enteric bypass, 16 percutaneous biliary intubation). Six patients were treated with PTCD and 7 received merely medical treatment- Results:the average survival period was 10. 8 ± 9. 7 months for the latter patients; tumor resection offered the best possibility of prolonged survival (21. 4±16. 7 months, P<0.01);choledochoenteric bypass yielded better survival than biliary intubation (P<0.05). It is concluded that aggressive radical resection is the best choice of treatment for extrahepatic common duct cancer. In riatients with unresectable tumor choledocho-entericshortcut drainage of bile is preferable.

关 键 词：胆管瘤 肝外胆管癌 外科手术 预后 

分 类 号：R735.805[医药卫生—肿瘤]