目的探讨Ⅲ、Ⅳ型肝门区胆管腺癌综合介入治疗的价值。方法21例经病理证实为肝门区胆管腺癌伴梗阻性黄疸的病例,CT、MR胰胆管成像、经皮经肝胆系造影术将其分为Ⅲ、Ⅳ型,采用内外引流术、多极射频消融术、胆管内支架置入术及动脉化疗灌注术序贯性治疗。结果所有肿瘤射频消融治疗1个月后CT值明显下降,13个病灶缩小约30%,4个病灶缩小约20%,4个病灶大小未变;6个月后均有缩小,缩小最显著者为60%左右,21个病灶平均缩小37%。有17例在射频消融治疗1个月后直接胆红素和间接胆红素恢复到正常水平,6个月后复查全部正常。随诊时间最长的为24个月,最短9个月,近期平均生存期14个月。结论综合介入治疗是Ⅲ、Ⅳ型肝门区胆管腺癌安全有效的治疗方法。 Objective To investigate the value of comprehensive interventional treatment of type Ⅲ and Ⅳ hilar cholangiocarcinomas. Methods Twenty-one cases of pathologic diagnosis of biliary adenocarcinoma of the hilum with obstructive jaundice were included in this study. CT and MR cholangiopancreatography were classified into three types and four types by percutaneous transhepatic cholangiography. Radiofrequency ablation, biliary stenting and arterial chemoembolization sequential therapy. Results The CT value of all tumors was significantly decreased after 1 month of radiofrequency ablation. Thirteen lesions were reduced by about 30%, four lesions were reduced by about 20%, and the size of four lesions was unchanged. After six months, the CT value decreased and decreased most significantly About 60%, 21 lesions on average reduced 37%. There were 17 cases of direct bilirubin and indirect bilirubin returned to normal levels one month after radiofrequency ablation, and all were normal after 6 months. The longest follow-up of 24 months, the shortest 9 months, the recent average survival of 14 months. Conclusions Comprehensive intervention is a safe and effective treatment for type Ⅲ and Ⅳ hilar cholangiocarcinomas.