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目的探讨两步评估方法对肝门部胆管癌术前评估价值。方法根据术前影像学资料,肝门部胆管癌的术前评估可分两步进行:首先对67例肝门部胆管癌病人进行改良T分期,并分析T分期对肿瘤切除率、手术方法的指导作用及与预后相关性;再采用改良T分期结合Bismuth分型方法分层,分析两者结合后对可治愈性手术方式选择及切除率的指导价值。结果改良T分期与肿瘤切除率、切缘阴性率及预后相关。随着T分期的增高,切除率及切缘阴性率显著下降(P= 0.032),T3期手术切除机会很小并且不能行治愈性切除;随T分期的增加,1、3年生存率下降(P<0.001)。但不同T分期的可治愈性手术方式无差异(P>0.05)。再结合Bismuth-Corlette分型表明T1/Bismuth-Ⅰ型的手术切除率和根治性切除率均显著高于其他分期/分型(P<0.05),T1及T2期治愈性手术方式符合Bismuth-Corlette分型手术原则。多普勒彩超联合MRI和MRCP对肿瘤的T分期、Bismuth分型最有价值。结论“两步评估方法”能较好地评估肿瘤可切除性、根治切除率及预后情况,并能指导具体的治愈性手术方式的选择,是一种理想的胆管癌术前评估方法。
Objective To investigate the preoperative evaluation of hilar cholangiocarcinoma by two-step evaluation. Methods According to preoperative imaging data, preoperative evaluation of hilar cholangiocarcinoma can be carried out in two steps: First, 67 cases of hilar cholangiocarcinoma were treated with modified T staging, and T staging was used to evaluate the tumor resection rate, surgical technique Guiding role and prognosis; using improved T staging combined with Bismuth classification method stratified, analysis of the combination of the two after curative surgery options and removal rate guidance value. Results The modified T stage was correlated with tumor resection rate, negative margin rate and prognosis. With the increase of T stage, the resection rate and marginal negative rate decreased significantly (P = 0.032). The surgical resection chance in T3 stage was small and could not be cured. With the increase of T stage, the 1,3 year survival rate decreased P <0.001). However, there were no differences in the cureable surgical methods between different T stages (P> 0.05). Combined with Bismuth-Corlette classification, T1 / Bismuth-Ⅰ type resection rate and radical resection rate were significantly higher than other staging / classification (P <0.05), T1 and T2 of the cure surgery in line with Bismuth-Corlette Typing surgery principle. Doppler ultrasound combined with MRI and MRCP T stage of the tumor, Bismuth classification of the most valuable. Conclusion The two-step evaluation method can better evaluate tumor resectability, radical resection rate and prognosis, and can guide the choice of specific curative surgery. It is an ideal preoperative evaluation method for cholangiocarcinoma.