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肝门胆管癌近年有增多趋势,本文报告我院1975年～1985年间肝门胆管癌60例,占全部肝外胆管癌82例之73.1％,占同期全部胆道手术3626例之1.65％。临床表现主要有三型:1)阻塞性黄疸29例,其中25例曾误诊为肝炎;2)急性胆管炎12例;3)长期胆道疾病14例,其他5例。本组行B超检查19例,ERCP10例,PTC39例。最后诊断根据PTC和/或ERCP,剖腹术及病理检查结果。 56例施行了手术治疗,仅6例施行肿瘤连同半肝切除,姑息性肝胆管内引流15例,外引流23例,其他方法12例。平均存活时间:6例切除组24.5月,48例姑息手术组8.7月,未手术的4例为5月。文中强调早期诊断,凡40岁以上出现阻塞性黄疸或“传染性肝炎”均须警惕胆管癌,进行B超,CT,ERCP或PTC检查,文中强调PTC是诊断本病重要手段,可选择进行右左肝管PTC。本病应争取手术切除,不能切除者行肝胆管内引流或外引流,二者疗效无明显差别。
In recent years, there has been an increasing trend of hilar cholangiocarcinoma. This paper reports 60 cases of hilar cholangiocarcinoma in our hospital from 1975 to 1985, accounting for 73.1% of 82 cases of all extrahepatic cholangiocarcinomas, accounting for 1.65% of all 3626 cases of biliary tract surgery in the same period. There are three types of clinical manifestations: 1) Obstructive jaundice in 29 cases, of which 25 cases were misdiagnosed as hepatitis; 2) 12 cases of acute cholangitis; 3) 14 cases of chronic biliary disease, the other 5 cases. The group underwent B-ultrasound in 19 cases, ERCP in 10 cases, and PTC in 39 cases. The final diagnosis was based on PTC and/or ERCP, laparotomy and pathological findings. Among the 56 patients who underwent surgical treatment, only 6 patients underwent tumors with hemihepatectomy, 15 patients underwent palliative hepatobiliary drainage, 23 patients underwent external drainage, and 12 patients underwent other methods. The average survival time was 64.5 months in the resection group, 48 months in the palliative surgery group, and 4 months in the unoperated group. The article emphasizes early diagnosis, obstructive jaundice or “infectious hepatitis” above 40 years of age must all be vigilant for cholangiocarcinoma, B-ultrasound, CT, ERCP or PTC examination, the text emphasizes that PTC is an important means of diagnosis of the disease, you can choose to right-left Hepatic PTC. The disease should strive for surgical resection, can not be resection of the line of hepatobiliary drainage or external drainage, the efficacy of the two no significant difference.