56例肝门部胆管癌外科治疗体会

【摘要】  目的 探讨肝门部胆管癌的诊断方法和外科治疗的疗效。方法 回顾性分析1996年1月至2006年1月间对56例肝门部胆管癌诊疗的临床资料及随访结果。结果 应用B超及MR等多种影像学技术对肝门部胆管癌的定位诊断率100%。56例行手术治疗，其中探查术5例，内、外引流术23例，均于术后2~15个月死亡。切除术28例(50.0%)，行根治性切除24例(42.9%)，中位生存期为29个月，姑息性切除4例，中位生存期为12个月。结论 超声检查联合MRCP能对肝门部胆管癌的定位诊断及评判手术切除有重要价值；根治性切除是改善肝门部胆管癌疗效的重要措施。

【关键词】  肝门部胆管癌；外科手术；治疗

Surgical treatment of hilar cholangiocarcinoma in 56 cases      

　　LI Xiaoou， WANG Ping， LI Chenglin， et al.
　　Department of General Surgery， the 306th Hospital of PLA， Beijing 100101
 
　　Abstract   Objective  To explore the therapeautic effect of the diagnosis and effective surgical treatment of hilar cholangiocarcinoma. Methods  The clinical data， diagnosis and the result of follow-up in 56 patients with hilar cholangiocarcinoma from January 1996 to January 2006 were analyzed retrospectively. Results  Fifty-six patients with hilar cholangiocarcinoma were diagnosed preoperatively by images of ultrasonograpy and MRCP， with 100% of the diagnostic accuracy rate. All cases were subjected to surgical treatment. Twenty-three cases treated with internal or external drainage had survived for 2~15 months. Tumor resection was performed in 28 cases (50.0%)， including radical resection in 24 cases (42.9%)， and the median survival time was 29 months. Four cases received palliative resection had a median survival period of 12 months. Conclusion  Ultrasonography plus MRCP has high accuracy in diagnosis of location and stage of the hilar cholangiocarcinoma. Radical resection definitely improves patient’s survival rate.
 
　　Key words   hilar cholangiocarcinoma； surgical procedures； therapy

　　肝门部胆管癌（hilar cholangiocarcinoma），又称Klatskin瘤，是指发生于左右肝管、肝总管及其汇合部的恶性肿瘤。解剖部位特殊，临床治疗困难，远期疗效欠佳。近年来，随着影像学技术的进步与完善，肝门部胆管癌的临床检出率明显提高，由于外科技术的进步，手术切除率及术后生存率均有显著改善，但就整体而言，对该病的手术治疗仍无实质进展[1-2]。我院自1996年1月至2006年1月间对56例肝门部胆管癌患者进行手术治疗，现对其

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