摘要
目的 总结 2 0年肝门部胆管癌外科治疗的经验 ,探讨提高切除率 ,减少并发症的有效措施。方法 回顾总结 1978年 1月～ 1997年 12月西南医院外科治疗 2 0 1例肝门部胆管癌的临床资料 ,以 1991年为界限前后分为两个阶段以对照手术切除率、并发症及死亡率等。结果 2 0 1例中手术切除 97例 ,非切除行胆道内、外引流者 84例 ,单纯剖腹探查 2 0例。切除组中根治切除 5 1例 ,姑息切除 46例。随访 75例中 ,根治切除者 1,3,5年生存率分别为95 45 %,40 91%,13 6 4%;姑息切除者 1,3年生存率为 5 5 %,10 %,无 5年生存者 ;非切除性胆道内、外引流者 1年生存率为 36 %,无 3年生存者 ;单纯剖腹探查者均于 3个月内死亡。两个阶段对照显示 :手术切除率由 1990年 12月以前的 34 95 %提高到以后的6 2 2 4%,其中根治切除率由 15 5 3%提高到 35 71%;手术并发症及死亡率分别由 39 8%和 17 84%降低到 18 37%和 6 12 %。结论 根治切除是提高肝门部胆管癌远期存活率的关键 ,合理的围手术期处理可降低手术并发症发生率及死亡率。
Objective To summarize twenty year experience in the surgical treatment of hilar cholangiocarcinoma(H CC) and explore the effective measuers for increase in resectional rate and reducing operative morbidity and mortality of H CC. Methods Clinicopathological data of 201 patients with H CC treated surgically in our center between 1978 and 1997 were analysed retrospectively. The resection rate, operative morbidity and mortality of the patients before and after December 1990 were compared. Results Of the 201 patients, 97 underwent resection(redical resection in 51; palliative in 46), 84 subjected to internal or external drainage and 20 only laparotomy. In 75 followed up patients, the 1,3,5 year survival rate was 95.45%, 40.91%, 13.64% in radical resection group, and 55%, 10%, 0% in palliative resection group respectively; whereas in unresectional internal and external drainage group, 1 year survival rate was 36%, noone survived for more than 3 years. All the patients with only laparotomy died within 3 months after operation. Comparation of the two stages revealed that the resection rate had been increased from 34.95% before December 1990 to 62.24% after December 1990, and the radical resection rate from 15.53% to 35.71%, meanwhile the operative morbidity and mortality decreased from 39.80% and 17.84% to 18.37% and 6.12% respectively. Conclusions Radical resection plays an important role for improving long term survival rate in patients with H CC. Appropriately perioperative care can reduce the operative morbidity and mortality.
出处
《中国普通外科杂志》
CAS
CSCD
2001年第1期6-10,共5页
China Journal of General Surgery
关键词
胆管肿瘤
腺癌
外科手术
治疗
胆管癌
BILE DUCT NEOPLASMS/surg
HEPATIC DUCT,COMMON/surg
ADENOCARCINOMA/surg
