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目的 研究影响肝门部胆管癌疗效的因素。方法 回顾性分析 1997～ 2 0 0 2年收治的198例肝门部胆管癌的临床资料。结果 198例的主要临床表现为黄疽 (94 5 % ,187例 )、瘙痒(5 6 6 % ,112例 )和腹痛 (33 8% ,6 7例 )。Bismuth CorletteⅠ型 14例 ,Ⅱ型 19例 ,Ⅲa型 12例 ,Ⅲb型 15例 ,Ⅳ型 112例 ,分型不清楚者 2 6例。手术切除 12 0例 (83 3% ) ,根治性切除 5 9例 (41 0 % ) ,姑息性切除 6 1例 ,剖腹探查胆道置管引流 2 4例 ,ERCP及PTCD内外引流 5 4例。 16例术后行放射治疗。术后生存时间与职业、术前最高血清总胆红素水平、手术方式和术后放疗四个因素显著相关。ENBD、ERBD或EMBE、胆道探查置管引流、肿瘤姑息切除、根治切除不同治疗方式的术后生存时间总体差异有显著意义 (χ2 =87 0 4 89,P <0 0 1)。结论 早期诊断和根治切除是提高肝门部胆管癌疗效的重要措施。
Objective To study the factors affecting the efficacy of hilar cholangiocarcinoma. Methods The clinical data of 198 cases of hilar cholangiocarcinoma admitted from 1997 to 2002 were analyzed retrospectively. Results The main clinical manifestations of 198 cases were jaundice (94.5%, 187 cases), pruritus (56.6%, 112 cases) and abdominal pain (33.8%, 67 cases). Bismuth Corlette type Ⅰ in 14 cases, type Ⅱ in 19 cases, type Ⅲ a in 12 cases, Ⅲ b in 15 cases, type Ⅳ in 112 cases, type 26 cases were not identified. Surgical resection was done in 120 cases (83.3%), radical resection in 59 cases (41%), palliative resection in 61 cases, laparotomy in 24 cases of biliary duct drainage, and extubation of ERCP and PTCD in 54 cases. 16 patients underwent radiotherapy. The postoperative survival time was significantly related to occupational factors, the highest preoperative serum total bilirubin level, operation mode and postoperative radiotherapy. ENBD, ERBD or EMBE, biliary exploration catheter drainage, tumor palliative resection, and radical resection of different treatment methods were significantly different in the overall survival time (χ 2 = 87 0 4 89, P 0 01). Conclusion Early diagnosis and radical resection are important measures to improve the curative effect of hilar cholangiocarcinoma.