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目的总结肝门部胆管癌手术治疗中提高根治切除率和减少并发症发生率的经验。方法回顾性分析1998年1月至2004年12月手术切除肝门部胆管癌病例的临床资料及随访结果。结果本组共54例患者切除肝门部胆管癌,切除率63.5%(54/85)。其中合并肝切除14例;合并胰头十二指肠切除3例;合并门静脉壁部分切除2例;合并肝固有动脉切除2例,重建1例。根治手术为30例。手术根治切除率由27.0%(2001年以前)提高到41.7%(2001年后),严重并发症如肝功能衰竭、感染的发生率以及围术期死亡率均得以良好控制。总体1、2、3年生存率为67.4%、28.1%和13.5%,根治手术1、2、3年生存率分别为86.5%、36.4%和23.7%,姑息切除1、2年生存率分别为41.2%和17.6%。结论提高肝门部胆管癌的手术技巧能够显著改善根治切除率,降低严重并发症发生率。
Objective To summarize the experience of improving the radical resection rate and reducing the complication rate in surgical treatment of hilar cholangiocarcinoma. Methods The clinical data and follow-up results of surgical resection of hilar cholangiocarcinoma from January 1998 to December 2004 were retrospectively analyzed. Results A total of 54 patients underwent resection of hilar cholangiocarcinoma in this study. The resection rate was 63.5% (54/85). Among them, 14 cases were complicated with hepatectomy, 3 cases with pancreatoduodenectomy, 2 cases with partial resection of portal vein wall, 2 cases with hepatic artery resection and 1 case reconstruction. Radical surgery for 30 cases. The radical resection rate increased from 27.0% (before 2001) to 41.7% (since 2001). Serious complications such as liver failure, the incidence of infection and perioperative mortality were well controlled. The overall 1, 2, 3-year overall survival rates were 67.4%, 28.1% and 13.5% respectively. The 1, 2 and 3-year survival rates after radical operation were 86.5%, 36.4% and 23.7% respectively. The 1- and 2-year palliative resection rates were 41.2% and 17.6%. Conclusion The surgical techniques to improve hilar cholangiocarcinoma can significantly improve the radical resection rate and reduce the incidence of serious complications.