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目的 提高肝外胆管癌的疗效。方法 38例肝外胆管癌,根治性切除12例,姑息性手术24例,单纯放射介入其他综合治疗4例。其中15例留置内支架,8例装入192Ir内放疗管。严重黄疸持续时间较长者术前经皮肝穿刺肝内胆管引流(PTCD)共6例,且术后继续停留导管并定期注入抗癌药物。复发病例争取再次手术2例。在数字减影技术(DSA)配合下行肝动脉栓塞(THAE)2例。先PTC造影后置入金属内支架3例。结果 存活期最短7个月,最长9年3个月,平均12.9个月。结论 肝外胆管癌应强调多学科综合治疗。术前PTCD有利于减轻阻塞性黄疸和减少术后并发症,其诊断价值高于B超和CT,术后继续留管可行腔内化疗。
Objective To improve the efficacy of extrahepatic cholangiocarcinoma. Methods Thirty-eight cases of extrahepatic cholangiocarcinoma were treated with radical resection in 12 cases, palliative operation in 24 cases, and radiation alone in other comprehensive treatment in 4 cases. Of these, 15 had indwelling stents and 8 had 192Ir internal radiotherapy tubes. Longer duration of severe jaundice was preceded by preoperative percutaneous transhepatic intrahepatic bile duct drainage (PTCD) in 6 patients, and catheters were continued after surgery and anticancer drugs were regularly injected. Relapsed cases sought reoperation in 2 cases. Digital subtraction technique (DSA) was used in conjunction with downhepatic artery embolization (THAE) in 2 cases. After PTC imaging, 3 metal stents were inserted. Results The survival period was the shortest 7 months and the longest was 9 years and 3 months, with an average of 12.9 months. Conclusion Extrahepatic bile duct cancer should emphasize multidisciplinary treatment. Preoperative PTCD is beneficial to reducing obstructive jaundice and reducing postoperative complications. Its diagnostic value is higher than that of B-ultrasonography and CT. Postoperative PTCD can continue to be managed with feasible intraluminal chemotherapy.