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目的探讨肝门部胆管癌的诊断及根治性切除方法。方法回顾性分析45例肝门部胆管癌的临床特点、根治性切除方法及治疗效果。结果本组术前均明确诊断。根治性切除45例,手术死亡5例(11．1％),胆漏5例(11．1％),其中2例并膈下脓肿,均经引流或再次手术引流治愈,右胸腔积液4例(8．9％),均经保守治疗治愈,切口裂开3例(6．7％),经再次缝合治愈。本组45例中,有36例(90．0％)获得随访,1,3年生存率,分别为91．7％,36．1％,无5年生存者。结论肝门部胆管癌早期诊断困难,联合应用影像学检查可明确诊断。本组根治性切除率仍较低,术后易复发和转移,鲜有长期生存者,手术死亡率仍较高。说明手术切除和清扫范围不够,手术技术有待进一步改进。
Objective To investigate the diagnosis and radical resection of hilar cholangiocarcinoma. Methods Retrospective analysis of 45 cases of hilar cholangiocarcinoma clinical features, radical resection and treatment. Results This group were diagnosed before surgery. There were 45 cases with radical resection, 5 cases with operative death (11.1%) and 5 cases with bile leakage (11.1%). Two of them were treated with subphrenic abscess and were cured by drainage or reoperation drainage. The right pleural effusion 4 Cases (8.9%) were cured by conservative treatment, wound incision in 3 cases (6.7%), cured again by suture. Of 45 cases, 36 cases (90.0%) were followed up, and the 1- and 3-year survival rates were 91.7% and 36.1% respectively, with no 5-year survival. Conclusions Early diagnosis of hilar cholangiocarcinoma is difficult, and combined with imaging examination can confirm the diagnosis. The group of radical resection rate is still low, easy to relapse and metastasis after surgery, little long-term survival, surgical mortality is still high. Description of surgical excision and cleaning is not enough scope, surgical techniques need to be further improved.