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目的探讨Ⅳ期胆囊癌侵犯肝门部胆管引起梗阻性黄疸的有效诊断和外科治疗方法。方法回顾性分析从2004年1月至2014年12月在我院治疗的128例及同期作者参与治疗的外院患者48例(共176例)病人的诊治和随访资料。结果在176例中确诊为TNM ⅣA期者占48.9%,ⅣB期者占51.1%。行手术探查组的94例(ⅣA期65例,ⅣB期29例)中,联合腹部超声、CT平扫+增强和开腹手术探查的诊断符合率为72.6%,联合腹部超声、CTA和腹腔镜手术探查者则为95.2%。行手术探查组中,ⅣA期44例行根治性切除术(中位生存时间/MST=14.3个月);ⅣA期21例和ⅣB期29例行姑息性切除或开腹外引流手术;未行手术探查组中所有82例均行保守或放弃治疗。结论联合腹部超声、CTA和腹腔镜手术探查诊断Ⅳ期胆囊癌的准确率较高。针对ⅣA期,行胆囊癌根治性切除术可获得明显疗效。针对ⅣB期,行PTCD或胆道支架置入术比较安全且一定程度上能改善病人生活质量。
Objective To investigate the effective diagnosis and surgical treatment of obstructive jaundice induced by gallbladder carcinoma of stage Ⅳ in hilar cholangiocarcinoma. Methods A retrospective analysis of 128 cases treated in our hospital from January 2004 to December 2014 and 48 cases (176 cases) of outpatients participated in the same period were retrospectively analyzed. Results Of the 176 cases, 48.9% were diagnosed as TNM ⅣA, 51.1% were ⅣB. In the 94 cases (65 cases of stage ⅣA and 29 cases of stage ⅣB) of the surgical exploration group, the coincidence rate of combined abdominal ultrasonography, CT scan + contrast enhancement and laparotomy was 72.6%. Combined with abdominal ultrasound, CTA and laparoscopy Surgical exploration was 95.2%. Surgical exploration group, 44 cases of ⅣA radical resection (median survival time / MST = 14.3 months); ⅣA 21 cases and Ⅳ B 29 cases of palliative resection or open drainage surgery; Surgical exploration group, all 82 cases were conservative or give up treatment. Conclusions The accuracy of combined abdominal ultrasound, CTA and laparoscopy in diagnosing stage IV gallbladder cancer is high. For Ⅳ A period, radical resection of gallbladder cancer can be significantly curative effect. For stage IVB, PTCD or biliary stent placement is safe and to a certain extent, improve the quality of life of patients.