【摘要】 目的　研究影响肝门部胆管癌切除的因素 ,探讨提高切除率的措施。方法　回顾性分析 34例肝门部胆管癌切除术的临床资料。结果　手术切除 1 9例 ,切除率 5 6 %。按Bismuth分型 ,Ⅰ、Ⅱ、Ⅲb、Ⅳ型切除率分别为 83%、1 0 0 %、1 0 0 %、33%。结论　影响切除率的局部因素为肿瘤的Bismuth分型、肿瘤近端胆管的长度和门静脉受累情况。BismuthⅠ、Ⅱ、Ⅲb型切除率较高 ,肿瘤近侧胆管至二级分支长度 >1 0cm、门静脉未受侵则切除可能较大。术前可通过PTC、MRCP、彩色多普勒和螺旋CT等检查估计其可能性。术中良好的显露和探查手法、术中B超、精细的肝门部解剖技术 ,必要时联合肝叶切除均有助于提高切除率。更多还原

【Abstract】 Objective To study the factor affecting resection rate and measures improving resection rate of Klatskin′s tumor. Methods The clinical records of 34 consecutive cases of Klatskin′s tumor were analyzed. Results The tumor was resected in 19 patients with a resection rate of 56%.According to Bismuth′s typing,the resection rates were 83%,100%,100% and 33% respectively. Conclusions The local factors affecting resection rate include Bismuth′s typing,the length of bile duct proximal to the tumor and the situation of portal vein infiltrated.The resection rates were higher in type Ⅰ,type Ⅱ and type Ⅲb than in type Ⅳ.The possibility of resection was larger when the length of proximal bile duct was over 1 0cm and portal vein was not infiltrated.The measures include PTC,MRCP,Color Dopper and Spiral CT may be used to evaluate the possibility of resection before operation.Adequate exposure,IOS,better exploration and anatomical skill,together with lobal hepatectomy when needed may be helpful for resection of Klatskin′s tumor.更多还原