中晚期肝门部胆管癌诊治15例

目的:探讨中晚期肝门部胆管癌的外科治疗方式选择,提高手术切除率和疗效.方法:对2001-10/2004-12收治的15例中晚期肝门部胆管癌的外科治疗方式和随访结果进行回顾性分析,其中中期7例(BismuthIIIa型4例,IIIb型3例),晚期(IV型)8例.结果:手术切除10例,非手术胆道支架内引流5例(IV型5例)随访14例(14/15,93.3%),手术切除组随访10例,中位生存期14.2mo(16d-32.3mo);非手术胆道支架内引流组随访4例,中位生存期3.8mo(1.3-7.2mo);两组中位生存期差异显著(t=2.802,P<0.05).结论:对于中晚期肝门部胆管癌,联合肝切除的姑息性肝门部胆管癌切除可显著延长患者生存期、提高生活质量,必要时辅以“架桥式”肝管空肠内引流对提高手术切除率、降低术后胆漏发生率具有重要作用.

Diagnosis and treatment for advanced hilar cholangiocarcinoma: an analysis of 15 cases

AIM: To evaluate the eff icacy of the surgical treatment for advanced hilar cholangiocarcinoma in order to en-hance the resection rate and the curative effect.METHODS: A retrospective analysis was performed on the data of 15 patients underwent surgical treatment for advanced hilar cholangiocarcinoma, including 7 mid-term cases (4 for Bismuth type IIIa, 3 for IIIb) and 8 late-term cases (Bismuth type IV).RESULTS: Ten patients underwent successful resec-tion, and 5 received non-surgical internal biliary stentdrainage, of which 14 patients were followed-up (93.3%, 14/15), including all the 10 cases in the surgical resec-tion group with the median survival time of 14.2 mo (16 d-32.3 mo). The median survival time for the patients received internal biliary stent drainage was 3.8 mo (1.3-7.2 mo), which was signif icantly different from that for the patients received surgical resection (t = 2.802, P <0.05).CONCLUSION: Palliative resection combined with hepatectomy can signif icantly prolong the survival time of the patients with advanced hilar cholangiocarcino-ma. Internal drainage through hepatico-jejunal bridge can enhance the surgical resection rate and decrease the occurrence rate of postoperative biliary f istula.