老年人肝门部胆管癌的外科治疗(附91例临床回顾分析)  

Surgical treatments of elderly patients with liver hilary cholangiocaicinoma

作　　者：过欣来[1] 杨永康[1] 尤天庚[1] 赵中辛[1] 

机构地区：[1]同济大学附属东方医院普外科,上海200120

出　　处：《腹部外科》2016年第4期293-296,共4页Journal of Abdominal Surgery

基　　金：上海市科委课题(10411968400)

摘　　要：目的报道老年肝门胆管癌病人的手术治疗结果。方法对1996年1月至2010年12月15年间收治老年肝门胆管癌病人91例(年龄65~83岁)的资料并进行分析。按照Bismuth分型:I型17例,Ⅱ型24例,Ⅲa型19例,Ⅲb型22例,Ⅳ型9例。其中外科手术治疗75例;胆道引流16例。根据治疗情况及手术类型分为三组:第1组:根治性切除术(R0切除组)44例;第2组:姑息切除(R1切除组)31例;第3组:胆道引流组(开腹经胆总管胆道内支架置入7例,行经皮肝穿刺引流9例)16例。围手术期死亡3例。死亡原因:肝衰竭2例,肺部感染1例。结果术后1年、2年、3年、5年生存率:R0切除组分别为68.18%、40.90%、31.81%、15.91%,中位生存期为(20±3)个月;R1切除组分别为64.52%、35.48%、22.58%、6.45%,中位生存期为(18±2)个月;胆道引流组分别为56.25%、6.25%、0%、0%,中位生存期为(13±1)个月。R0组与R1组术后生存率相仿(x^2=7.39,P=0.0582);R0组术后生存率优于胆道引流组(x^2=34.45,P=0.0016);R1组术后生存率也优于胆道引流组(x^2=26.18,P=0.0037)。结论认真、仔细、严格的术前准备,合理手术方式,积极处理合并症,老年肝门胆管癌病人可获得良好的手术疗效;手术治疗是老年肝门胆管癌病人的首选方法。本组R0切除组与R1切除组治疗效果明显优于胆道引流组。即便是R1切除,也能获得与R0切除相似的疗效。Objective To report the surgical treatments of elderly patients with hilary cholan- giocarcinoma. Methods The clinical data of 91 patients （aged 65-83 years old） with hilary cholangio- carinoma admitted to our hospital from January 1996 to December 2010 were analyzed. According to the Bismuth classification., there were 17 cases of type Ⅰ, 24 cases of type Ⅱ, 19 cases of Ⅲa, 22 cases of typeⅢ, and 9 cases of type Ⅳ. Before operation, all patients had jaundice （total bilirubin 113- 422 mol/L and direct bilirubin 89-315 tool/L）. Radical resection was performed on 75 cases, and postoper- ative pathological examination confirmed R0 resection in 44 cases and R1 in 31 cases. Sixteen cases were treated by common bile duct stent implantation or percutaneous transhepatic cholangial drainage. There were 3 perioperative deaths （liver function failure in 2 cases, and pulmonary infection in 1 case）. Results The 1-, 2-, 3- and 5-year postoperative survival rate in R0, R1 and stent drainage groups was 68.18%, 40.90%, 31.81%, 15.91%;64.52%, 35.48%, 22,58%, 6.45%, and 56. 25%, 6. 25%, 0%, 0%, respectively （P = 0. 0582）. The 2-year survival rate after operation in R0 and R1 groups was 40. 90% and 35. 48% correspondently, which was significantly higher than in stent drainage group （6. 25%, P = 0. 0037）. The 3-year survival rate after operation in R0 and R1 groups was 31.81 % and 22. 58% correspondently, which was higher than that in stent drainage group （0%, P〈0. 0016）. No patients could survive more than 3 years in the stent drainage group. ConclusionsCareful and strict preoperative preparation, reasonable operation, aggressive treatment of complica- tions could achieve a satisfactory surgical resection benefit in elderly patients with hilary cholangiocar- einoma. Even in the R1 group, the 3-year survival rate after operation was higher than that in the stent drainage group.

关 键 词：老年人 肝门胆管癌 手术 

分 类 号：R735.8[医药卫生—肿瘤]