论文部分内容阅读
目的总结肝门部胆管癌的诊断及外科治疗。方法回顾性分析1972—2001年收治的肝门部胆管癌165例的临床资料。结果根据不同时期的发病例数、手术切除率不同,分为前15年第一阶段及后15年的第二阶段。首发症状为上腹不适或闷痛、胀痛、乏力、食欲减退及进行性黄疸。B 超、CT、MRI 和 MRCP 是无损伤诊断的首选方法;若显示肝内胆管扩张或诊断肝外梗阻性黄疸,则应行 PTC(27例)、MRCP(15例)或 ERCP(78例)。本组手术切除73例,切除率44.2%,其中根治性切除38例:非根治性切除35例。第一阶段切除15例,切除率27.3%;第二阶段切除58例,切除率52.7%。本组54例得到随访,其中根治性切除术5年生存率39.5%,非根治性切除术为14.3%;未切除的62例得到随访,均于1～1.5年死亡。结论一旦诊断为肝门部胆管癌,就应积极剖腹探查,不要延误切除时机。手术切除是治疗肝门部胆管癌的最有效的治疗方法。
Objective To summarize the diagnosis and surgical treatment of hilar cholangiocarcinoma. Methods The clinical data of 165 cases of hilar cholangiocarcinoma admitted from 1972 to 2001 were retrospectively analyzed. Results According to the number of cases in different periods, the rate of resection was different and divided into the first stage and the second stage after 15 years in the first 15 years. The first symptom of abdominal discomfort or tenderness, pain, fatigue, loss of appetite and progressive jaundice. B ultrasound, CT, MRI and MRCP are the first choice for non-invasive diagnosis. PTC (27 cases), MRCP (15 cases) or ERCP (78 cases) should be performed if intrahepatic bile duct dilatation or extrahepatic obstructive jaundice is indicated. . The group of surgical resection in 73 cases, resection rate was 44.2%, of which radical resection in 38 cases: non-radical resection in 35 cases. In the first stage, 15 cases were resected and the resection rate was 27.3%. In the second stage, 58 cases were resected and the resection rate was 52.7%. The group of 54 patients were followed up, of which 5-year radical resection survival rate was 39.5%, non-radical resection was 14.3%; 62 cases were not removed were followed up, were in 1 to 1.5 years of death. Conclusion Once the diagnosis of hilar cholangiocarcinoma, laparotomy should be actively explored, do not delay the timing of resection. Surgical resection is the most effective treatment for hilar cholangiocarcinoma.