肝门部胆管癌的外科治疗  

Surgical treatment of hilar cholangiocarcinoma

作　　者：秦兴雷[1] 鲁敏[1] 王作仁[2] 贾萌[1] 王林[2] 张云锋[3] 李珂[1] 薛焕洲[1] 

机构地区：[1]郑州大学人民医院肝胆外科,450003 [2]西安交通大学第一医院普外科,450003 [3]郑州大学人民医院肿瘤外科,450003

出　　处：《中华普通外科杂志》2012年第12期966-969,共4页Chinese Journal of General Surgery

基　　金：卫生部科学研究基金（WKJ2008-2-013）;河南省重点科技攻关（082102310086）

摘　　要：目的探讨肝门部胆管癌的临床特征、治疗方法对远期生存率的影响。方法对1995--2005年收治的98例肝门部胆管癌的l临床特点、诊断及随访结果进行回顾性分析，并将手术方式和治疗效果进行对比研究。根据数据类型分别进行χ2检验、t检验，生存率计算采用Kaplan-Meier法，并作log-rank检验。结果83例施行了外科手术，15例施行保守治疗。83例中行根治性切除术者33例，姑息性切除术者16例，内或外引流术者34例。肝门部胆管癌切除者1、3、5年生存率分别为79％、42％、17％，其中根治性切除1、3、5年生存率分别为88％、54％、24％；姑息性切除1、3年生存率分别为55％、9％，无5年存活者。根治性切除、姑息性切除生存率差异有统计学意义（10g-ranktest，P〈0．001）。结论根治性切除是提高肝门部胆管癌远期生存率及改善生活质量的有效手段，早期诊断和治疗是提高远期疗效的关键。Objective To investigate the clinical features and the prognosis after surgical treatment for hilar cholangiocarcinoma （HCC）. Methods The surgical therapy and follow-up result were retrospectively analyzed on 98 cases of hilar cholangiocarcinoma admitted into our hospital from January 1995 to January 2005. Differences between groups were evaluated using Chi-square analysis or Student t-test according to the data type. Survival rate was calculated with Kaplan-Meier method, and using the log-rank test. Results Among 98 patients, 83 patients underwent surgical treatment （radical resection in 33, palliative resection in 16, and nonresectional internal or external bile duct drainage in 34）, 15 patients underwent conservative therapy. The 1-, 3-, 5-year survival rates were 79%, 42%, and 17% in the resection group and 88%, 54%, and 24% in the radical resection group, respectively. The 1-, 3-year survival rates were 55%, and 9% in palliative resection group, respectively, and none of the patient survived for over 5 years. There were significant differences in the survival rate among the radical resection group and the palliative resection group （log-rank test, P 〈 0. 001 ）. Conclusions Radical resection improves the prognosis of hilar cholangiocarcinoma.

关 键 词：胆管肿瘤 胆道外科手术 预后 

分 类 号：R735.8[医药卫生—肿瘤]