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目的 :研究分析 134例肝门部胆管癌临床诊治及远期疗效 ,探讨生存率与手术方式的关系及如何提高早期诊断率。方法 :分析解放军总医院肝胆外科 1999年 1月至 2 0 0 2年 7月收治的肝门部胆管癌 134例。结果 :手术组 116例 ,其中根治性切除 4 8例 ,姑息性切除 2 1例 ,胆道引流 4 7例 ;非手术组 18例。总手术率 86 .6 %( 116 / 134) ,根治性切除率 4 1.2 % ( 4 8/ 116 )。根治性切除组 1,2 ,3年生存率分别为 75 .0 %、4 5 .8%、2 5 .0 % ,姑息性切除组为 5 0 %、16 .7%、0 ,两组之间的生存率比较有显著性差异 (P <0 .0 5 ) ;胆道引流组为 2 5 %、10 %、0 ;非手术组平均存活 5 .7个月 ,无一例超过 1年。结论 :肝门部胆管癌的治疗以手术为主 ,个体化和实用性的根治性切除术才能获得最佳疗效。对无黄疸性慢性肝病及胃肠道症状者定期体检及必要的影象学检查 ,是早期发现肝胆管癌的积极手段 ,赢得高生存率
Objective: To study and analyze 134 cases of hilar cholangiocarcinoma clinical diagnosis and long-term curative effect, explore the relationship between survival rate and surgical approach and how to improve the early diagnosis rate. Methods: 134 cases of hilar cholangiocarcinoma admitted from January 1999 to July 2002 in General Hospital of PLA General Hospital were analyzed. Results: In the operation group, 116 cases were cured, including 48 cases of radical resection, 21 cases of palliative resection and 47 cases of biliary drainage; 18 cases of non-operation group. The total operative rate was 86.6% (116/134) and the radical resection rate was 4.12% (48/116). The 1,2-year and 3-year survival rates of the radical resection group were 75.0%, 45.8% and 25.0%, respectively. Palliative resection group was 50% and 16.7% There was significant difference between the two groups (P <0.05). The biliary drainage group was 25%, 10% and 0 respectively. The average survival time of the non-operation group was 5.7 months, and no one was more than 1 year. Conclusions: The treatment of hilar cholangiocarcinoma is surgery-based, and individualized and practical radical resection can obtain the best curative effect. Regular jaundice on chronic liver disease and gastrointestinal symptoms and physical examination of the necessary imaging, early detection of hepatobiliary cancer is an active means to win a high survival rate