Bismuth Ⅳ型肝门部胆管癌的外科治疗  

Surgical treatment for type Ⅳ hilar cholangiocarcinoma

作　　者：陈永标[1] 江艺[1] 张绍庚[1] 陈少华[1] 吕立志[1] 林华[1] 

机构地区：[1]南京军区福州总医院肝胆外科,福建福州350025

出　　处：《中国普通外科杂志》2007年第7期621-623,共3页China Journal of General Surgery

摘　　要：目的探讨BismuthⅣ型肝门部胆管癌的外科治疗方法。方法对近5年来经手术和病理确诊的22例BismuthⅣ型肝门部胆管癌患者的临床资料进行回顾性分析。结果22例患者中,男13例,女9例,男女之比1.4∶1。常规手术方法治疗16例(常规手术治疗组),包括手术切除5例(31.3%),其中根治性切除2例,姑息切除3例;内或外引流术11例。经典式原位肝移植术6例(肝移植组)。常规手术方法治疗组1,2年累积生存率分别为32.1%,0;肝移植组除1例术后11个月死于慢性排异反应外,余均健康存活,现已分别存活28,19,17,12个月和9个月,未见肿瘤复发和转移,术后1,2年累积生存率分别为80.0%(4/5),50.0%(1/2)。两组生存率比较差异有显著性(P=0.041)。结论BismuthⅣ型肝门部胆管癌应行积极的外科治疗,其中根治性切除术是提高患者存活率的关健;常规手术无法根治切除者是原位肝移植的适应证,术后疗效满意。Objective To explore the surgical management in patients with Bismuth 1V hilar cholangiocarcinoma. Methods Retrospective study was used to analyze the clinical data with operative and pathologic diagnosis of Bismuth Ⅳ hilar cholangiocareinoma in the recent five years. Results Of the 22 patients, there were 13 males and 9 females, with M ： F = 1. 4 ： 1. In the group of non. liver transplantation （ NLTX ） , 5 cases （ 31.3 % ） underwent resection （ radical resection in 2 cases ; palliative resection in 3 cases ） , and 11 cases had nonresectional internal or external drainage. In the liver transplantation group （ LTX ） , the resection rate was 100% （6/6）. Five LTX cases survived for 28, 19, 17, 12 and 9 months respectively, and one died from chronic rejection in 11 months after operation. In the NLTX group, the 1-and 2-yr survival rate was 32. 1% and 0% respectively. The 1-and 2-yr survival rate of LTX was 80. 0 % （4/5） and 50. 0 % （1/2） respectively. There was significant difference between the two groups in average survival rate （P=0.041）. Conclusions Aggressive surgical treatment should be adopted for Bismuth Ⅳ hilar cholangiocarcinoma, and radical resection is crucial to enhance survival rate. LTX is a good choice for the patients with unresectable Bismuth Ⅳ hilar cholangiocarcinoma and the prognosis is satisfactory.

关 键 词：胆管肿瘤/外科学 肝门部胆管癌 肝移植 

分 类 号：R735.8[医药卫生—肿瘤]