肝切除在肝门胆管癌根治术中应用

目的 总结肝切除在肝门部胆管癌根治术中应用经验.方法 回顾分析1993年1月至2007年12月手术切除的肝门部胆管癌病人临床资料及随访结果.结果 全组共有69例肝门胆管癌,切除率66.4%(69/104).其中局部切除31例;合并肝叶部分切除38例;合并胰头十二指肠切除3例;合并门静脉壁部分切除2例.根治手术为44例.手术根治切除率由28.2%(2000年以前)提高到50.8%(2000年后),肝功能衰竭、感染等严重并发症以及围术期死亡率均控制较好.总体1,2,3年生存率为73.9%,38.4%和14.9%,根治手术1,2,3年生存率分别为87.1%,58.2%和23.6%,非根治切除1,2,3年生存率分别为44.0%,21.6%和11.4%.结论 根治性切除的生存率比非根治切除显著提高,联合肝部分切除能明显提高根治性手术的切除率,可考虑为首要的治疗选择.

Experience in radical resection of proximal bile duct cancer by hepatectomy

Objective To summarize the experience in hepatectomy for radical resection of proximal bile duct cancer.Methods Retrospective analysis was made on the clinical data of 104 consecutive cases undergoing resection of proximal bile duct cancer by hepatectomy from January 1993 to December 2007.Results Of the 104 patients,69 received tumor resection with a resection rate of 66.4 %.Combined partial hepatectomy was performed in 38 patients,combined pancreaticoduodenectomy (Whipple) in 3 and combined resection of portal vein in 2.Forty-four patients had radical resection.The radical resection rate was greatly increased from 28.2% (before 2000) to 50.8% (after 2000) in this group with well controlled perioperative mortality and postoperative complications rate (hepatic failure and major infection etc.).The gross 1-,2-,and 3-year survival rates for the whole group were73.9%,38.4% and14.9%,respectively.The 1-,2-,and 3-year survival rates for radical resection were 87.1%,58.2% and 23.6%,respectively.The 1-,2-,3-year survival rates for palliative resection were 44.0%,21.6% and 11.4 %.Conclusion Survival rates are better in patients undergoing radical resection than those receiving palliative operation.Resection of proximal bile duct cancer by hepatectomy results in better clinical outcomes,suggesting that it can be considered the standard treatment of the first choice.