肝门部胆管癌的诊断治疗
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高明 E-mail:gaoming164@126.com

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Diagnosis and treatment of hilar cholangiocarcinoma
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    摘要:

    目的:探讨肝门部胆管癌的临床特点,以期提高对肝门部胆管癌的诊治水平。
    方法:回顾性分析收治的98例肝门部高位胆管癌的临床资料。诊断主要依靠肿瘤标志物及影像学检查,最终病理确诊。
    结果:按Bismuth-corlitte分型,Ⅰ型8例,Ⅱ型19例,Ⅲa型17例,Ⅲb型14例,Ⅳ型40例。根治切除49例,姑息手术12例,内引流16例,PTCD 5例。根治性切除组平均中位生存期28.6个月,其1,2,3,5年生存率分别为74.2%,65.3%,37.5%和3.9%。姑息手术组平均中位生存期17.6个月,其1,2,3,5年生存率分别为71.7%,26.8%,8.9%和0%。内引流组平均中位生存期4.5个月,其1,2,3,5年生存率分别为21%,13%,0%和0%。
    结论:肝门部胆管癌典型临床表现出现晚,早期诊断必须依靠辅助检查,根治性手术仍是提高疗效和改善预后的惟一有效手段。治疗方式的选择应多元化,且应个体化。

    Abstract:

    Objective: To improve the level of diagnosis and treatment of hilar cholangiocarcinoma by investgating it′s clinical characteristics.
    Methods: The clinical data of 98 patients with hilar cholangiocarcinoma were analyzed retrospectively.
    Results: According to the  Bismuth-Corlitte grouping: typeⅠ, 8 cases; typeⅡ, 19 cases; type Ⅲ, 17 cases; type Ⅲb, 14 cases; and type Ⅳ, 40 cases. Radical resection(49), palliative operation(12), endoscopic retrograde biliary drainage(16), and PTCD(5) were performed The median survival time of radical resection group was 28.6 months and the survival rate at 1, 2, 3, and 5 years was 74.2%,65.3%,37.5%, and 3.9% respectively, while the median survival time of palliative operation group was 17.6 months and the survival rate at 1, 2, 3, and 5 years was 71.7%,26.8%,8.9%, and 0% respectively. The median survival time of endoscopic retrograde biliary drainage group was 4.5 months and the survival rate at 1, 2, 3, and 5 years was 21%,13%, and 0% respectively.
    Conclusions: Early diagnosis by adjunctive examinations is vital to treatment of hilar cholangiocarcinoma. Radical resection is the sole procedure to improve the outcome and prognosis of hilar cholangiocarcinoma. Multiple therapeutic methods should be adopted and should be individualized.

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高明| 项和平| 耿小平| 张长乐.肝门部胆管癌的诊断治疗[J].中国普通外科杂志,2010,19(8):896-898.
DOI:10.7659/j. issn.1005-6947.2010.08.015

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  • 收稿日期:2010-04-16
  • 最后修改日期:2010-06-13
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  • 在线发布日期: 2010-08-15