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目的总结肝门部胆管癌的外科治疗经验。方法回顾性分析2009年1月至2011年7月期间哈尔滨医科大学附属第二医院胆胰外科收治的87例肝门部胆管癌患者的临床和随访资料。结果本组87例肝门部胆管癌患者手术切除率为67.8%(59/87),其中根治性切除率即R0切除率为48.3%(42/87),R1切除率为11.5%(10/87),姑息性切除即R2切除率为8.0%(7/87)。本组无围手术期死亡患者。42例获得R0切除的患者术后1、3、5年生存率分别为92.9%(39/42)、31.0%(13/42)、19.0%(8/42);R2切除和内外引流患者均无超过3年的患者,10例R1切除者1年生存率为70.0%(7/10)、2年生存率为20.0%(2/10),7例R2切除者1年生存率为57.1%(4/7),28例内外引流患者1年生存率为35.7%(10/28)。R1、R2切除患者的1、3、5年生存率均明显低于R0切除者(P<0.05)。结论对于肝门部胆管癌,根治性手术是唯一可能治愈的方法,术前精确评估、经皮经肝穿刺胆管引流解除胆管梗阻、合理的肝脏切除、术中行切缘冰冻病理检查是根治性切除的重要保障;姑息性切除仍可延长患者生存期及提高生活质量。
Objective To summarize the surgical experience of hilar cholangiocarcinoma. Methods The clinical and follow-up data of 87 patients with hilar cholangiocarcinoma admitted to the Second Affiliated Hospital of Harbin Medical University from January 2009 to July 2011 were retrospectively analyzed. Results The surgical resection rate of 87 patients with hilar cholangiocarcinoma in this group was 67.8% (59/87), of which the radical resection rate was 48.3% (42/87), the resection rate of R1 was 11.5% (10 / 87), palliative resection that R2 resection rate of 8.0% (7/87). This group of patients without perioperative death. The survival rates at 1, 3 and 5 years were 42.9% (39/42), 31.0% (13/42) and 19.0% (8/42) respectively in 42 patients with R0 resection. The patients with R2 resection and those with internal and external drainage The 1-year survival rate was 70.0% (7/10) in 10 cases of R1 excision and 20.0% (2/10) in 2 cases. The 1-year survival rate of 7 cases of R2 excision was 57.1% (4/7). The 1-year survival rate was 35.7% (10/28) in 28 patients with internal and external drainage. The 1-year, 3-year and 5-year survival rates of patients with R 1 and R 2 resections were significantly lower than those with R 0 resection (P 0.05). Conclusions For radical hilar cholangiocarcinoma, radical surgery is the only possible cure. Precise preoperative evaluation, percutaneous transhepatic biliary drainage to relieve bile duct obstruction, rational hepatectomy, and surgical resection of the marginal frost pathology are radical resections Of the important guarantee; palliative resection can still prolong the survival of patients and improve the quality of life.