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目的总结103例肝门部胆管癌采用手术切除治疗的经验。方法回顾性分析10年来行手术切除的肝门部胆管癌103例患者的临床资料和随访结果。结果本组行根治性(R0)切除43例,根治性切除率为41．7％,非根治性(R1,R2)切除60例(58．30%),术后发生并发症34例,手术死亡8例。根治性切除组中位生存期29．9个月,1、3、5年生存率分别为69．6％、42．0％、20．9％,明显优于非根治性切除组34．1％、10．2％、0(P<0．05)。本组近5年术前减黄治疗42例,合并肝切除达53．8％,根治性切除率达45．7％,中位生存期24．7个月,疗效明显提高(P<0．05)。结论肝门部胆管癌作根治性手术切除能更好延长患者生存期,使手术治疗获得良好的疗效。随着近年来加强围手术期处理、术中行切缘冰冻病理检查、联合肝切除等提高了肝门部胆管癌根治性切除率。
Objective To summarize the experience of surgical resection in 103 cases of hilar cholangiocarcinoma. Methods The clinical data and follow-up results of 103 patients with hilar cholangiocarcinoma who underwent resection in 10 years were retrospectively analyzed. Results In this group, 43 patients underwent radical resection (R0), radical resection was 41.7%, and 60 patients (58.30%) were treated with non-radical (R1, R2) resection. 34 patients had postoperative complications, 8 died. In the radical resection group, the median survival time was 29.9 months, and the 1,3 and 5-year survival rates were 69.6%, 42.0% and 20.9%, respectively, which were significantly better than the non-radical resection group 34.1 %, 10.2%, 0 (P <0.05). In the past 5 years, 42 cases were treated with preoperative reduction of yellow, 53.8% were treated with hepatectomy, and the radical resection rate was 45.7%. The median survival time was 24.7 months. The curative effect was significantly improved (P <0. 05). Conclusions Histopathological resection of hilar cholangiocarcinoma can prolong the survival of patients and achieve good therapeutic effect. In recent years, with the strengthening of perioperative management, intraoperative marginal frozen pathological examination, combined with hepatectomy to improve the radical resection of hilar cholangiocarcinoma.