摘要
目的：总结肝门部胆管癌的诊治经验及存在的问题。方法：回顾２０年来１６８例肝门部胆管癌临床资料并结合近年部分病例随访结果，分析和讨论。结果：全组手术治疗１２７例，保守治疗４１例。术前超声和ＣＴ联合检查使梗阻部位和病变性质确诊率分别提高到９７．４％和９４．７％。肝门区淋巴结和肝十二指肠韧带结缔组织及肝脏是较早和最常见的转移部位。全组总切除率为３５．９％，近５年切除率提高到５０．０％。合并有肝门区局部转移者切除后１年复发率８０．０％，３年复发率１００％，平均复发时间术后７．６月。未见转移者术后１年复发率１４．３％，３年复发率７１．４％，平均复发时间术后１６．５月。结论：肝门部胆管癌病例数近年来有上升趋势。术前超声和ＣＴ联合检查一般能够满足诊断，应尽量避免有创性和侵入性检查。为减少复发，尽可能地切除肝门区淋巴、神经纤维、脂肪和纤维结缔组织，有时甚至包括右侧腹腔神经节，应当是治愈性切除术的基本要求之一。
Objective: To review the experience in the diagnosis and surgical treatment of the hilar carcinoma of the bile duct. Methods: The data of 168 patients with hilar carcinoma of the bile duct surgically treated in our department in the past 20 years were retrospectively analyzed. Results: The preoperative diagnostic rates for the location and nature of the lesion were respectively raised to 97.4% and 94.7% with ultrasonography in combination with CT. 142 patients underwent operations had a total resective rate of 35.9%, which reached 50% in recent five years. Follow-up of patients who received curative resections showed a one year recurrent rate of 80.0% and a three-year recurrent rate of 100.0% with a mean recurrent time of 7.6 months in patients with local metastasis in contrast to 14.3%, 71.4% and 16.5 months in those without metastasis. Conclusion: The number of cases of hilar carcinoma of bile duct tends to increase in recent years. Ultrasonography and CT are helpful for the diagnosis. To reduce the recurrent rate, resection of the tumor together with the lymph, the nerve fibers, the fat and the connective tissues in the hepatic hilus and sometimes even the right celiac ganglia should be regarded as the necessary procedure.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
1998年第3期249-251,共3页
Journal of Third Military Medical University
