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目的 探讨肝门部胆管癌的诊断及手术治疗方法。方法 回顾性分析 73例肝门部胆管癌的临床特点、手术方法及治疗效果。结果 本组术前均明确诊断。B超诊断符合率为 6 9 9%。根治性切除 15例 ,近期效果良好 ;各种胆管内外引流术 43例 ,37例获缓解 ,手术后死亡 6例 ;剖腹探查或肝动脉插管化疗 15例 ,术后短期内病情无变化。获根治性切除 15例中 ,11例得到随访 ,1,3年生存率分别为 90 9% ,2 0 0 % ,无 5年生存者。其他各种术式的生存时间无超过 9个月者。结论 肝门部胆管癌早期诊断仍困难 ,联合应用影像学检查可明确诊断 ,B超为首选检查方法。目前根治性切除率仍较低 ,肝方叶切除对最后选定手术方式有一定帮助。
Objective To investigate the diagnosis and surgical treatment of hilar cholangiocarcinoma. Methods The clinical features, surgical methods and therapeutic effects of hilar cholangiocarcinoma in 73 cases were retrospectively analyzed. Results The diagnosis was confirmed before operation in this group. The B-ultrasound diagnosis rate was 69.9%. Radical resection in 15 cases, the recent good results; a variety of bile duct drainage in 43 cases, 37 cases were relieved, 6 cases died after surgery; laparotomy or hepatic artery catheterization chemotherapy in 15 cases, no change in the short-term postoperative condition. Of the 15 patients who received radical resection, 11 were followed up. The 1-year and 3-year survival rates were 90 9% and 20%, respectively. There was no 5-year survival. The survival time of other various surgical procedures is less than 9 months. Conclusion The early diagnosis of hilar cholangiocarcinoma is still difficult. The combined use of imaging examination can confirm the diagnosis. B ultrasound is the preferred method. At present, the radical resection rate is still low, and the liver lobectomy will help the final selected surgical approach.