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目的 总结 2 0年肝门部胆管癌外科治疗的经验 ,探讨提高切除率 ,减少并发症的有效措施。方法 回顾总结 1978年 1月～ 1997年 12月西南医院外科治疗 2 0 1例肝门部胆管癌的临床资料 ,以 1991年为界限前后分为两个阶段以对照手术切除率、并发症及死亡率等。结果 2 0 1例中手术切除 97例 ,非切除行胆道内、外引流者 84例 ,单纯剖腹探查 2 0例。切除组中根治切除 5 1例 ,姑息切除 46例。随访 75例中 ,根治切除者 1,3,5年生存率分别为95 45 %,40 91%,13 6 4%;姑息切除者 1,3年生存率为 5 5 %,10 %,无 5年生存者 ;非切除性胆道内、外引流者 1年生存率为 36 %,无 3年生存者 ;单纯剖腹探查者均于 3个月内死亡。两个阶段对照显示 :手术切除率由 1990年 12月以前的 34 95 %提高到以后的6 2 2 4%,其中根治切除率由 15 5 3%提高到 35 71%;手术并发症及死亡率分别由 39 8%和 17 84%降低到 18 37%和 6 12 %。结论 根治切除是提高肝门部胆管癌远期存活率的关键 ,合理的围手术期处理可降低手术并发症发生率及死亡率。
Objective To summarize the experience of surgical treatment of hilar cholangiocarcinoma in 20 years and to explore effective measures to increase resection rate and reduce complications. Methods The clinical data of 201 cases of hilar cholangiocarcinoma treated surgically in the Southwest Hospital from January 1978 to December 1997 were retrospectively reviewed. The results were divided into two phases before and after the 1991 limit as the control resection rate, complications, and death. Rate and so on. Results Of the 201 cases, 97 were surgically removed, 84 were non-removable and the other was biliary tract drainage, and 20 were simple exploratory laparotomy. In the resection group, radical resection was performed in 51 cases and palliative resection in 46 cases. In the 75 patients with follow-up, the 1-, 3-, and 5-year survival rates of radical resection were 95.45 %, 40 91%, and 13 6 4%, respectively; the 1-year, 3-year survival rate of palliative resection was 55 %, 10 %, no 5 The annual survivors, the non-resectable biliary tract, and the external drainage had a one-year survival rate of 36%, and no survival for three years; only laparotomy patients died within three months. Two-stage comparison showed that the surgical resection rate increased from 34.95% before December 1990 to the following 6 2 2 4%, with radical resection rate increased from 15 53% to 35 71%; surgical complications and mortality From 39 8% and 17 84% respectively to 18 37% and 6 12%. Conclusion Radical resection is the key to improve the long-term survival rate of hilar cholangiocarcinoma. Rational perioperative management can reduce the incidence of surgical complications and mortality.