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目的探讨肝门部胆管癌的临床分型、治疗方案和疗效。方法选择2008年1月至2011年2月诊治的135例肝门部胆管癌患者作为研究对象,回顾性分析患者的临床分型、治疗情况及预后。结果 135例肝门部胆管癌患者中,Bismuth分型法:Ⅰ型39例,Ⅱ型27例,Ⅲ型25例、Ⅳ型34例、Ⅴ型10例。其中行切除术51例,包括根治性切除术21例、姑息性切除术30例。未切除84例,包括胆-肠吻合术28例、胆道置管引流术36例、金属支架置入术17例、放弃治疗3例。Ⅰ～Ⅱ型的18个月和24个月生存率分别为78.8%和63.6%,Ⅲ～Ⅴ型的18个月,24个月生存率分别为62.3%和44.9%,组间差异有统计学意义(P<0.05)。切除组患者的12个月、18个月和24个月生存率分别为88.2%、80.4%和72.5%,未切除组患者的12个月、18个月和24个月生存率分别为73.8%、63.1%和47.6%,组间差异有统计学意义(P<0.05)。结论肝门部胆管癌的临床分型、治疗方案直接影响患者预后,临床上要根据患者具体病情选择适合的治疗方案,延长患者生存时间。
Objective To investigate the clinical classification, treatment plan and curative effect of hilar cholangiocarcinoma. Methods A total of 135 patients with hilar cholangiocarcinoma who were diagnosed and treated from January 2008 to February 2011 were selected as the research object. The clinical classification, treatment and prognosis of the patients were retrospectively analyzed. Results Among 135 cases of hilar cholangiocarcinoma, Bismuth classification method included 39 cases of type Ⅰ, 27 cases of type Ⅱ, 25 cases of type Ⅲ, 34 cases of type Ⅳ and 10 cases of type Ⅴ. Among them, 51 cases were performed excision, including 21 cases of radical resection and 30 cases of palliative resection. 84 cases were not removed, including 28 cases of gallbladder-intestine anastomosis, 36 cases of biliary duct drainage and drainage, 17 cases of metal stent implantation and 3 cases of abandonment of treatment. The 18-month and 24-month survival rates of type Ⅰ-Ⅱ were 78.8% and 63.6% respectively. The 18-month and 24-month survival rates of type Ⅲ-Ⅴ were 62.3% and 44.9% respectively. There were statistically significant differences between groups Significance (P <0.05). Survival rates at 12 months, 18 months and 24 months in the resection group were 88.2%, 80.4% and 72.5%, respectively. Survival rates at 12 months, 18 months and 24 months in the resection group were 73.8% , 63.1% and 47.6%, respectively. The differences between the two groups were statistically significant (P <0.05). Conclusions The clinical classification and treatment of hilar cholangiocarcinoma directly affect the prognosis of patients. Clinically, according to the specific conditions of patients, we should select appropriate treatment options to prolong the survival time of patients.