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目的探讨肝门部胆管癌的临床特点及诊治体会。方法对32例肝门部胆管癌患者的临床资料进行回顾性分析。结果 32例患者术前行B超、CT、磁共振胰胆管造影(MRCP)检查,诊断确诊率达100%。其中Bismuth-Corlette分型Ⅰ型3例,Ⅱ型6例,Ⅲa型11例,Ⅲb型9例,Ⅳ型3例。32例均行手术治疗,其中根治性切除17例,姑息性切除6例,内引流4例,外引流4例,剖腹探查活检1例。根治性切除、姑息性切除、内引流和外引流患者术后中位生存时间分别为32.4个月、18.3个月、11.5个月、4.3个月。结论联合运用影像学检查方法可提高肝门部胆管癌的诊断率。根治性切除是提高肝门部胆管癌患者疗效的最有效方法 ,对无法行根治性切除者应积极进行引流治疗,可改善患者生存质量,延长生存时间。
Objective To investigate the clinical features, diagnosis and treatment of hilar cholangiocarcinoma. Methods The clinical data of 32 patients with hilar cholangiocarcinoma were analyzed retrospectively. Results 32 patients underwent preoperative B-ultrasound, CT, magnetic resonance cholangiopancreatography (MRCP) examination, the diagnostic diagnosis rate of 100%. Bismuth-Corlette type Ⅰ in 3 cases, type Ⅱ 6 cases, Ⅲ a type 11 cases, Ⅲ b type 9 cases, type Ⅳ in 3 cases. Thirty-two cases underwent surgical resection, including radical resection in 17 cases, palliative resection in 6 cases, internal drainage in 4 cases, external drainage in 4 cases and laparotomy in 1 case. The median survival time after radical resection, palliative resection, internal drainage and external drainage were 32.4 months, 18.3 months, 11.5 months and 4.3 months respectively. Conclusion Combined use of imaging examination can improve the diagnosis of hilar cholangiocarcinoma. Radical resection is to improve the efficacy of hilar cholangiocarcinoma patients the most effective method of radical resection of those who can not be actively treated by drainage can improve the quality of life of patients and prolong survival.