肝門膽管癌外科治療療效評價_《華西醫學》

作者：

宗帝 ^1,2 ,  曾勇 ¹

1四川大學華西醫院肝膽胰外科（成都，610041）;2四川省醫學科學院·四川省人民醫院整形外科;

關鍵詞：

肝門膽管癌外科治療評價

DOI：

10.7507/1002-0179.20130437

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目的　對肝門膽管癌外科治療療效進行評價。方法　回顧分析2007年3月－2012年3月收治的156例肝門膽管癌患者的臨床資料。按手術方式將患者分為手術切除組（n=45）、膽道引流組（n=78）和姑息治療組（n=33），并對住院期間并發癥發生率、病死率及生存時間等進行分析。結果　156例患者根治性切率為23.1%不同治療方式住院期間病死率差異無統計學意義（P＜0.05）；手術治療組與姑息治療組并發癥發生率差異有統計學意義（P＜0.05）。手術切除組、膽道引流組、姑息治療組的1、3、5年累積生存率分別為64.4%、17.8%、0.0%；40.2%、12.6%、12.6%；17.7%、7.1%、0.0%，手術切除組生存情況明顯好于其他兩組（P＜0.05）。結論　不建議所有患者術前均引流可減黃，且可以不過分強調R0切除。膽道引流可一定程度改善預后，但近遠期膽道感染相關并發癥發生率較高。

引用本文： 宗帝,曾勇. 肝門膽管癌外科治療療效評價. 華西醫學, 2013, 28(9): 1387-1389. doi: 10.7507/1002-0179.20130437 復制

1.	李波, 嚴律南. 肝門膽管癌的診治進展[J]. 中國普外基礎與臨床雜志, 2005, 12(4): 356-360.
2.	Blechacz B, Gores GJ. Cholangiocarcinoma: advances in pathogenesis, diagnosis, and treatment[J]. Hepatology, 2008, 48(1): 308-321.
3.	顧勁揚, 仇毓東, 周建新, 等. 膽管癌發病機制及治療進展[J]. 肝膽外科雜志, 2010, 18(5): 385-388.
4.	萬紫微, 李松崗, 楊勇, 等. 肝門部膽管癌外科手術治療進展[J].肝膽外科雜志, 2009, 17(6): 469-471.
5.	周寧新, 黃志強, 馮玉泉, 等. 肝門部膽管癌根治性切除手術方式的改進[J]. 中華普通外科雜志, 2001, 16(2): 82-84.
6.	Nishio H, Nagino M, Nimura Y. Surgical management of hilar cholangiocarcinoma: the Nagoya experience[J]. HPB (Oxford), 2005, 7(4): 259-262.
7.	Miyazaki M, Kato A, Ito H, et al. Combined vascular resection in operative resection for hilar cholangiocarcinoma: does it work or not?[J]. Surgery, 2007, 141(5): 581-588.
8.	Hemming AW, Kim RD, Mekeel KL, et al. Portal vein resection for hilar cholangiocarcinoma[J]. Am Surg, 2006, 72(7): 599-604.
9.	Chen D, Lai JM, Liang LJ, et al. Combination with vascular resection and reconstruction in resection of hilar cholangiocarcinoma[J]. Chin J Surg, 2011, 49(7): 607-610.
10.	Schiffman SC, Reuter NP, McMasters KM. Overall survival peri-hilar cholangiocarcinoma: R1 resection with curative intent compared to primary endoscopic therapy[J]. J Surg Oncol, 2012, 105(1): 91-96.
11.	Hidalgo E, Asthana S, Nishio H, et al. Surgery for hilar cholangiocarcinoma: the Leeds experience[J]. Eur J Surg Oncol, 2008, 34(7):787-794.
12.	Kennedy TJ, Yopp A, Cin Y, et al. Role of preoperative biliary drainage of liver remnant prior to extended liver resection for hilar cholangiocarcinoma[J]. HPB (Oxford), 2009, 11(5): 445-451.
13.	Nagino M, Kamiya J, Uesaka K, et al. Complications of hepatectomy for hilar cholangiocarcinoma[J]. World J Surg, 2001, 25(10): 1277-1283.
14.	Khuntikeo N, Pugkhem A, Bhudhisawasdi V, et al. Major hepatic resection for hilar cholangiocarcinoma without preoperative biliary drainage[J]. Asian Pac J Cancer Prev, 2008, 9(1): 83-85.

1. 　李波, 嚴律南. 肝門膽管癌的診治進展[J]. 中國普外基礎與臨床雜志, 2005, 12(4): 356-360.
2. 　Blechacz B, Gores GJ. Cholangiocarcinoma: advances in pathogenesis, diagnosis, and treatment[J]. Hepatology, 2008, 48(1): 308-321.
3. 　顧勁揚, 仇毓東, 周建新, 等. 膽管癌發病機制及治療進展[J]. 肝膽外科雜志, 2010, 18(5): 385-388.
4. 　萬紫微, 李松崗, 楊勇, 等. 肝門部膽管癌外科手術治療進展[J].肝膽外科雜志, 2009, 17(6): 469-471.
5. 　周寧新, 黃志強, 馮玉泉, 等. 肝門部膽管癌根治性切除手術方式的改進[J]. 中華普通外科雜志, 2001, 16(2): 82-84.
6. 　Nishio H, Nagino M, Nimura Y. Surgical management of hilar cholangiocarcinoma: the Nagoya experience[J]. HPB (Oxford), 2005, 7(4): 259-262.
7. 　Miyazaki M, Kato A, Ito H, et al. Combined vascular resection in operative resection for hilar cholangiocarcinoma: does it work or not?[J]. Surgery, 2007, 141(5): 581-588.
8. 　Hemming AW, Kim RD, Mekeel KL, et al. Portal vein resection for hilar cholangiocarcinoma[J]. Am Surg, 2006, 72(7): 599-604.
9. 　Chen D, Lai JM, Liang LJ, et al. Combination with vascular resection and reconstruction in resection of hilar cholangiocarcinoma[J]. Chin J Surg, 2011, 49(7): 607-610.
10. 　Schiffman SC, Reuter NP, McMasters KM. Overall survival peri-hilar cholangiocarcinoma: R1 resection with curative intent compared to primary endoscopic therapy[J]. J Surg Oncol, 2012, 105(1): 91-96.
11. 　Hidalgo E, Asthana S, Nishio H, et al. Surgery for hilar cholangiocarcinoma: the Leeds experience[J]. Eur J Surg Oncol, 2008, 34(7):787-794.
12. 　Kennedy TJ, Yopp A, Cin Y, et al. Role of preoperative biliary drainage of liver remnant prior to extended liver resection for hilar cholangiocarcinoma[J]. HPB (Oxford), 2009, 11(5): 445-451.
13. 　Nagino M, Kamiya J, Uesaka K, et al. Complications of hepatectomy for hilar cholangiocarcinoma[J]. World J Surg, 2001, 25(10): 1277-1283.
14. 　Khuntikeo N, Pugkhem A, Bhudhisawasdi V, et al. Major hepatic resection for hilar cholangiocarcinoma without preoperative biliary drainage[J]. Asian Pac J Cancer Prev, 2008, 9(1): 83-85.

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肝門膽管癌外科治療療效評價

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