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目的分析34例胆管下端癌患者外科治疗的特点和疗效。方法回顾性分析1958至2003年收治的34例胆管下端癌患者的临床资料。结果1958至1976年胆管下端癌13例,切除5例(38.5%);1977至1987年胆管下端癌1例,手术切除1例(100.0%);1988至1998年胆管下端癌4例,手术切除2例(50.0%);1999至2003年胆管下端癌16例,手术切除12例(75.0%)。1977至2003年期间胆管下端癌的发生率呈增加趋势,手术切除率也明显增加;术前总胆红素水平平均值呈下降趋势。1999至2003所有的胰十二指肠切除患者术前均未行减轻黄疸处理,并发症仍然显著降低,术中输血量较前明显减少。结论随着围手术期治疗和监护技术的进步,对梗阻性黄疸病理生理的深入认识,使胆管下端癌患者的手术病死率和并发症发生率均显著下降。
Objective To analyze the characteristics and the curative effect of surgical treatment of 34 patients with lower bile duct carcinoma. Methods The clinical data of 34 patients with lower bile duct carcinoma who were treated from 1958 to 2003 were analyzed retrospectively. Results From 1958 to 1976, 13 cases of lower bile duct carcinoma were excised and 5 cases were excised (38.5%). One case of biliary ductal carcinoma (1 case, 100.0%) was removed from 1977 to 1987. Surgical resection was performed in 4 cases 2 cases (50.0%); 16 cases of lower bile duct cancer from 1999 to 2003, 12 cases (75.0%) were resected surgically. The incidence of lower bile duct cancer increased from 1977 to 2003, and the surgical resection rate also increased significantly. The average preoperative total bilirubin level showed a decreasing trend. All patients with pancreatoduodenectomy from 1999 to 2003 had no prior treatment of jaundice and the complications were still significantly reduced. The volume of blood transfusions during operation was significantly reduced. Conclusion With the progress of perioperative treatment and monitoring techniques, the deep understanding of the pathophysiology of obstructive jaundice has led to a significant decrease of the operative mortality and the complication rate of patients with lower biliary duct cancer.