目的评价大范围肝切除治疗伴有梗阻性黄疸的肝门部胆管癌术前胆道引流的作用。方法回顾性研究2005年6月至2011年4月在解放军总医院行大范围肝切除治疗的伴有梗阻性黄疸的肝门部胆管癌患者临床及术前影像学资料,测量预留肝体积,根据公式:余肝体积(RLV)/标准总肝体积(SLV)计算标准余肝率(standardizedremnant liver volume ratio,SRLVR)。根据术前胆道引流与否,分为两个亚组,比较两亚组术后近期结果。结果大范围肝切除治疗的伴有梗阻性黄疸的肝门部胆管癌共117例,所有病例均进行了肝体积测量,平均标准余肝率为52.3%,术后病死率为6.8%,总并发症发生率为41.9%,肝衰竭发生率为14.5%,感染性并发症发生率为9.7%,术后平均住院日数17.8 d(5～64 d)。多因素分析显示,SRLVR≤40%(OR:71.63,95%置信区间:8.07～635.96,P<0.001)和术前总胆红素>186.7μmol/L(OR:17.29,95%置信区间:1.97～151.92,P=0.01)为肝门部胆管癌术后肝衰竭的独立危险因素。SRLVR>40%时术前胆道引流亚组感染性并发症发生率显著高于非引流亚组,两亚组间术后病死率、总并发症发生率、肝衰竭发生率、术后住院日数差异无统计学意义,而SRLVR≤40%时,术前胆道引流亚组术后病死率、肝衰竭发生率、术后住院日数显著小于非引流亚组,两亚组间总并发症发生率、感染性并发症发生率差异无统计学意义。结论肝门部胆管癌伴有梗阻性黄疸患者肝切除术前,SRLVR≤40%时术前胆道引流显著降低术后病死率、肝衰竭发生率及术后住院日数,推荐常规使用术前胆道引流,而SRLVR>40%时术后感染性并发症发生率显著增加,选择性使用术前胆道引流更为合适。 Objective To evaluate the effect of extensive hepatectomy on preoperative biliary drainage of hilar cholangiocarcinoma with obstructive jaundice. Methods The clinical and preoperative imaging data of patients with hilar cholangiocarcinoma with obstructive jaundice treated by extensive liver resection from June 2005 to April 2011 in People’s Liberation Army General Hospital were retrospectively studied. The volume of reserved liver, Standard standardized residual liver volume ratio (SRLVR) was calculated according to the formula: residual liver volume (RLV) / standard total liver volume (SLV). According to preoperative drainage of the biliary tract or not, divided into two subgroups, comparing the two subgroups postoperative short-term results. Results A total of 117 cases of hilar cholangiocarcinoma accompanied by obstructive jaundice were treated by extensive hepatectomy. The liver volume was measured in all cases. The average standard residual hepatic rate was 52.3% and the postoperative mortality was 6.8% The incidence of disease was 41.9%, the incidence of liver failure was 14.5%, the incidence of infectious complications was 9.7%, and the average postoperative hospital stay was 17.8 days (5-64 days). Multivariate analysis showed that SRLVR ≤40% (OR: 71.63,95% confidence interval: 8.07-635.96, P <0.001) and preoperative total bilirubin> 186.7μmol / L (OR: 17.29,95% confidence interval: 1.97 ~ 151.92, P = 0.01) were independent risk factors for postoperative liver failure in hilar cholangiocarcinoma. The prevalence of infectious complications in preoperative biliary drainage subgroup was significantly higher than that in non-drainage subgroup when SRLVR> 40%. The postoperative mortality, the incidence of total complication, the incidence of liver failure, No statistical significance, and SRLVR≤40%, preoperative biliary drainage subgroups postoperative mortality, the incidence of liver failure, postoperative hospitalization was significantly less than the non-drainage subgroups, the total complication rate between the two subgroups, infection There was no significant difference in the incidence of sexual complications. Conclusions Preoperative biliary drainage significantly reduces the postoperative mortality, the incidence of liver failure and the number of days of hospitalization after SRLVR ≤ 40% before hepatectomy in patients with hilar cholangiocarcinoma with obstructive jaundice. Preoperative preoperative biliary drainage is recommended , While the incidence of postoperative infectious complications was significantly increased when SRLVR> 40%. It is more appropriate to selectively use preoperative biliary drainage.