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目的:分析评价肝外胆管癌的诊断方法和外科治疗的临床效果。方法:回顾性分析本院自1995年1月至2004年3月间收治的73例肝外胆管癌的病理特点,临床诊断及外科治疗方法和随访结果。其中上、中、下段及弥漫性胆管癌分别为49例(67.1%),13例(17.8%),10例(13.7%)及1例(1.4%)。结果:本组中50～79岁者和以梗阻性黄疸为首发症状者均占79.5%。入院前误诊率40.1%,术前诊断准确率95.9%。B超,CT,MRI+MRCP和PTC诊断符合率分别为81.9%(59/72),84.2%(27/31),93%(40/43)和88.9%(16/18);而B超+CT及B超+CT+MRCP联合诊断符合率分别为93.5%(29/31)和100%(14/14)。35例经手术及病理检查证实,其中腺癌占94.3%,腺鳞癌为5.7%。47例行手术治疗(64.4%),11例行PTCD或ERCD引流减黄,15例放弃治疗。手术切除22例(切除率46.8%),姑息性内外引流术25例,二者手术并发症率及死亡率为45.5%与40%和13.6%与8%,并均无统计学差异。手术切除术组中19例获得随访,保险法中位生存期(排除围手术期死亡病例)为26月(1.2～69+月),3例存活超过3年,均为中段胆管癌。现仍存活2例,生存期分别为43月及69月。手术引流组随访患者16例,保险法中位生存期为8月(1.8～15+月)。介入引流组随访患者7例,保险法中位生存期为5.5月(2～20月)。两组引流治疗者均无一例存活超过2年,而放弃治疗者均死于确诊后4月内。手术切除组疗效优于其他治疗组(P<0.05),而手术引流及介入引流减黄治疗有明显地改善生活质量,延长生存期的作用。结论:肝外胆管癌早期诊断仍困难,误诊率较高,联合应用现代影像学无创检查技术新提医科大学医学硕士学位论文可提高早期诊断率及术前确诊率并且对肿瘤可切除性判断及制定手术方案有重要指导意义,有助于提高肝外胆管癌的切除率。目前手术切除仍然是治疗肝外胆管癌最有效手段,部分患者可获得治愈性切除而长期生存,而有效的手术或介入引流减黄治疗方法是不能切除的肝外胆管癌主要的有效治疗方法。关键词肝外胆管肿瘤;诊断;外科治疗RetrosPective Analysis of 73 Patients with ExtrahePatie Bile Duet CareinomasDePartment of General Surgery,First Teaching HosPital,Xinjiang Medical UniversityMSc Student:Akbar Ali SuPervisor:Prof. Wen Hao,A/Prof. Zhang Xin FengAbstraCtObjective:To summarize methods for diagnosis and treatments ofPatients with extrahePatie bile duet eareinomas.Methods:RetrosPeetiveanalysis based on elinieoPathology,diagnostie methods,surgiealaPProaehes and follow一uP data,were earried out for 73 eonseeutivePatients with extrahePatie bile duet eareinomas treated in our hosPitalbetween January 1 995 and Mareh 2004.In this series,there were 49(67.1%)for uPPer一third eareinomas,13(17.8%)for middle一thirdeareinomas,10(1 3 .7%)for lower一third eareinomas andl(1 .4%)fordiffiise eareinomas.Results:The 79.5%of the Patients were between50一79 years old,the same Pereentage was observed in the Patients withProgressive jaundiee as initial symPtom.The rate of Pre一admissionmisdiagnoses and the aeeuraey of PreoPerative diagnoses were 40.1%and95.9%resPeetively.Diagnostie aecuracy was 81.9%(59/72)for