论文部分内容阅读
目的 介绍我们对肝门胆管癌分型诊断和治疗经验。方法 我科治疗肝门胆管癌 2 2例 ,根据PTC结果作出Bismuth分型诊断。Ⅰ、Ⅱ型早期手术局部切除后胆肠吻合术 ,ⅢB 型左肝切除、加局部切除后胆肠吻合术 ,ⅢA、Ⅳ型支撑管留置后装放疗。结果 后装放疗 10例 ,均因慢性胆汁性肝硬变、肝功能衰竭死亡 ,死亡时间从术后 3个月～ 18个月 ,平均 8个月。无后装期 2例 ,死于术后 2月。左肝叶切除 1例 ,术后胆系造影、B超、TBIL正常 ,术后 4个月失访。肿瘤切除 2例 ,1例术后 8个月肝门胆管癌复发 ,术后 10个月死亡 ;1例术后 10个月肝转移 ,术后 14个月死亡。结论 PTC对肝门胆管癌的术前诊断和Bismuth分型的重要作用是其它检查不能完全取代的。术前根据肝门胆管癌的Bismuth分型和有无肝转移即可决定治疗方案。能使生存期延长的根本方法是早期诊断 ,使阻塞性黄疸发生的时间短 ,免于发生胆汁性肝硬变 ,后装放疗明显延长生存期
Objective To introduce our experience in the diagnosis and treatment of hilar cholangiocarcinoma. Methods Our department treated 22 cases of hilar cholangiocarcinoma, according to PTC results to make a Bismuth classification diagnosis. Type I and type II early postoperative local excision of biliary-enteric anastomosis, type IIIB left hepatectomy, plus partial excision of biliary-enteric anastomosis, IIIA, IV type support tube indwelling and radiotherapy. Results After loading radiotherapy in 10 cases, all died of chronic biliary cirrhosis and hepatic failure. The death time ranged from 3 months to 18 months after surgery, with an average of 8 months. No post-loading period occurred in 2 cases and died after 2 months. Left hepatectomy was performed in one patient. Postoperative gallbladder angiography, B-ultrasonography, and TBIL were normal and were lost to follow-up at 4 months. Two patients had tumor resection, one patient had recurrence of hilar cholangiocarcinoma at 8 months after operation, and he died 10 months after surgery. One patient had hepatic metastasis at 10 months after surgery and died 14 months after surgery. Conclusion The important role of PTC in the preoperative diagnosis and Bismuth classification of hilar cholangiocarcinoma is that other tests cannot completely replace it. Preoperative Bismuth classification based on hilar cholangiocarcinoma and the presence or absence of liver metastases can determine the treatment plan. The fundamental method that can extend the survival period is early diagnosis, so that the time for obstructive jaundice is short, and biliary cirrhosis is avoided. After-treatment radiotherapy significantly prolongs survival.