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解放军总医院肝胆外科自1986.1～1990.12间共手术治疗肝门部胆管癌45例,其中手术切除者29例,切除率为64.4％。切除组术后存活12个月者占41.4％,24个月者占20.7％;而未切除组生存未超过12个月。手术切除彻底与切缘发现残癌者愈后亦有显著差异,前者18个月仍存活者占28.6％,而后者无一例生存达18个月。术后死亡者在切除组多于6～12个月内肿瘤复发或再出现黄疸。结果显示术后残癌和复发多见于局部切除者,其病理类型与癌浸润程度之间无明显区别。提高远期疗效的关键是手术能否达到根治性切除的目的,必须充分估计沿胆管壁癌细胞浸润范围,在不超出剩余肝组织代偿能力的前提下,扩大联合肝叶切除的根治范围有可望提高远期生存率。
The Department of Hepatobiliary Surgery of General Hospital of PLA has treated 45 cases of hilar cholangiocarcinoma from 1986.1 to 1990.12, including 29 cases of surgical resection. The resection rate was 64.4%. In the resection group, 41.4% of the patients survived after 12 months, and 20.7% of the patients survived after 24 months. The survival rate of the unexcised group was less than 12 months. There was also a significant difference between the surgical resection and the cutting edge. The former was still surviving at 28.6% after 18 months, while the latter had no survival of 18 months. Postoperative death occurred in more than 6 to 12 months after resection in the resection group or recurrence of jaundice. The results showed that postoperative residual cancer and recurrence were more common in local resection, and there was no significant difference between its pathological type and degree of cancer infiltration. The key to improving long-term curative effect is whether or not the operation can achieve the purpose of radical resection. We must fully estimate the extent of invasive cancer cells along the bile duct wall. Without increasing the compensatory ability of the remaining liver tissue, we can expand the scope of the combined liver lobectomy. It is expected to improve long-term survival.