论文部分内容阅读
目的：总结肝门部胆管癌的诊治经验及存在的问题。方法：回顾２０年来１６８例肝门部胆管癌临床资料并结合近年部分病例随访结果，分析和讨论。结果：全组手术治疗１２７例，保守治疗４１例。术前超声和ＣＴ联合检查使梗阻部位和病变性质确诊率分别提高到９７．４％和９４．７％。肝门区淋巴结和肝十二指肠韧带结缔组织及肝脏是较早和最常见的转移部位。全组总切除率为３５．９％，近５年切除率提高到５０．０％。合并有肝门区局部转移者切除后１年复发率８０．０％，３年复发率１００％，平均复发时间术后７．６月。未见转移者术后１年复发率１４．３％，３年复发率７１．４％，平均复发时间术后１６．５月。结论：肝门部胆管癌病例数近年来有上升趋势。术前超声和ＣＴ联合检查一般能够满足诊断，应尽量避免有创性和侵入性检查。为减少复发，尽可能地切除肝门区淋巴、神经纤维、脂肪和纤维结缔组织，有时甚至包括右侧腹腔神经节，应当是治愈性切除术的基本要求之一。
Objective: To summarize the diagnosis and treatment experience and problems of hilar cholangiocarcinoma. Methods: The clinical data of 168 cases of hilar cholangiocarcinoma over the past 20 years were reviewed and combined with the follow-up results of some cases in recent years, analyzed and discussed. Results: In the whole group, 127 cases were treated surgically and 41 cases were conservatively treated. Preoperative ultrasound and CT examinations improved the diagnostic rate of obstructive sites and lesions to 97.4% and 94.7%, respectively. Hilar lymph node and hepatoduodenal ligament connective tissue and liver are the earlier and most common sites of metastasis. The overall resection rate was 35.9%, and the resection rate increased to 50.0% in the past 5 years. The recurrence rate was 80.0% at one year after resection with local metastases from the porta hepatis. The recurrence rate was 100% at 3 years and the average recurrence time was 7.6 months after surgery. None of the metastatic patients had a recurrence rate of 14.3% at 1 year after surgery, a recurrence rate of 71.4% at 3 years, and an average recurrence time of 16.5 months after surgery. Conclusion: The number of cases of hilar cholangiocarcinoma has increased in recent years. Preoperative ultrasound and CT combined examination can generally meet the diagnosis, and invasive and invasive examinations should be avoided as far as possible. To reduce recurrence, removal of the hepatic lymph nodes, nerve fibers, fat and fibrous connective tissue as much as possible, and sometimes even the right celiac ganglion, should be one of the basic requirements for curative resection.