80年代以来,发现癌性高位胆管梗阻的病例有所增多,但多数患者发现时已属晚期,根治性切除机会甚少。依全国胆道外科学组1989年协作会议调查报告,高位胆管癌手术切除率仅占10.4%。对于术中发现病变不能切除的患者,若不作任何解除胆道梗阻的措施,常由于进行性胆道梗阻、胆管炎,导致肝衰而加速死亡。如何提高其存活时间及生活质量,关键在于设法保持胆道通畅和恢复胆肠引流。国内外已有报告姑息手术后,存活2～3年的病例,我们亦有1例仅行活检加U管引流,术后辅以化疗、免疫治疗,至今已带瘤存活6年半。故对此类病人,应采取积极的姑息治疗。 Since the 1980s, the number of cases of cancerous high bile duct obstruction has increased, but most patients have been found to be advanced and there is little chance of radical resection. According to the investigation report of the 1989 Collaborative Meeting of the National Biliary Surgery Group, the rate of surgical resection of high-grade cholangiocarcinoma was only 10.4%. For patients whose lesions cannot be removed during surgery, without any measures to relieve biliary obstruction, progressive biliary obstruction and cholangitis often lead to liver failure and accelerate death. How to improve its survival time and quality of life, the key lies in trying to maintain biliary patency and recovery of gallbladder and intestinal drainage. At home and abroad, we have reported cases of 2 to 3 years of survival after palliative surgery. We also had 1 patient who only had biopsy plus U-tube drainage, supplemented by chemotherapy and immunotherapy after surgery, and had survived for 6 and a half years. Therefore, active palliative care should be taken for such patients.