肝门部胆管癌的外科治疗:291例回顾

目的 分析一个单位1986年-2002年间治疗肝门部胆管癌291例的经验。方法 回顾1986年-2002年在解放军总医院肝胆外科治疗291例肝门部胆管癌的纪录,病例分为2组:Ⅰ组:1986年1月-1999年1月,共157例;Ⅱ组为1999年2月-2002年6月,共134例。外科治疗手段包括根治性切除术、姑息性切除术或内、外胆道引流术,主要是依据手术中所发现的病理情况决定。根治性切除术的标准是指切除的边缘病理上未发现残留癌细胞者。根治性切除率在两组分别为37.6％和41.2％。无切除术后30天内死亡。随访结果是通过信件、电话及门诊获得,随访率为88.8％。结果 在我国,肝外胆管癌是并非少见的疾病,近年来手术治疗的病例数有增多倾向。然而,由于肿瘤居于肝门部胆管的深在位置,所以根治性切除手术有困难,甚至联合肝切除亦难以达到根治目的,因而在两组病例中,根治性切除率分别仅为37.6％和41.2％。在第Ⅰ组中,有4例病人于切除术后长期无瘤生存,5年以上生存率为13.3％;另有2例病人亦生存达5年以上,但癌复发,现仍在接受进一步治疗。在第Ⅱ组中尚未有5年生存者,3年生存率为13.6％。结论 肝门部胆管癌是多态性的疾病,只有极少数表现为较“良性”的倾向,而绝大多数则于手术切除后易于复发,虽然手术似乎是已达治愈性。切除性治疗,甚至是姑息性切

Surgical treatment of hilar bile duct cancer: A critical review of 291 cases

Objective To summarize the clinical experience in the treatment of hilar bile duct carcinoma in a single institute through 1986–2002. Methods 291 cases admitted to the General Hospital of P. L. A. were reviewed. The cases were divided into two groups: Group I, cases were admitted from 1986.1 to 1999.1, totally 157 cases; and Group II included cases which were treated from 1999.2 to 2002.6, totally 134 cases. The methods of surgical treatment included radical resection, palliative resection, external or internal drainage, according to the pathology found during surgery. Radical resection (free of residual tumor cells at the resection edge of the resected specimens) was 37.6% in group I and 41.2% in group II, respectively. There was no death within 30 days after resectional operation. Follow-up data was obtained through correspondence and outpatient department visits with the follow-up rate being 88.8%. Results Carcinoma of the proximal extrahepatic bile duct was not a rare disease in China and the number of operations on bile duct cancer was increased in recent years. Owing to the location of the tumor, radical resection was difficult to reach even supplemented by liver lobe resection. Radical resection rate was from 37.6% to 41.2% in these two series of cases studied. There were 4 cases of tumor-free survivals in the group I (13.3%), and furthermore, there were also 2 cases with tumor recurrence and still under treatment. In group II, there was no 5 year survivals and the 3-year survival rate was 13.6%. Conclusion Carcinoma of the hilar bile duct is a disease of multiformity. Rarely, it may behave a rather benign course, but, in the majority, the disease was likely to be recurrent even after a seemingly radical resection. However, resectional treatment, even palliative, may prolong life and improve the quality of life. The value of extended resection and lymph nodes dissection operation is still uncertain.