【摘要】 目的研究肝门部胆管癌的临床肿瘤行为和外科治疗效果。方法回顾性分析1980年1月～2005年12月单机构收治的92例患者的临床表现、肿瘤行为和术后生存。结果肝门部胆管癌的主要临床症状为黄疸(97%,89例)、体重下降(39%,36例)、上腹不适(33%,30例)、上腹痛(27%,25例)。90%(83例)SGPT升高、37%(34例)低蛋白血症。Bismuth分型Ⅰ型29%(27例)、Ⅱ型22%(20例)、Ⅲ型16%(15例)、Ⅳ型33%(30例)。总体手术并发症33%(30例)、手术死亡率3%(3例)。39%(36例)切除、切缘阴性率53%(19例)。不能切除的患者62%(35例)局部广泛侵犯,39%侵犯大血管(22例),21%(12例)远处转移。总体中位生存8个月,手术切除后25个月、非切除性手术后5个月(P<0.0001)。结论局部侵犯(特别是大血管侵犯)和远处转移是肝门部胆管癌不能切除的主要原因。手术切除能够显著提高术后生存。更多还原

【Abstract】 Objective To investigate the clinico-oncological behavior and surgical effect of perihilar cholangiocarcinoma.Methods A retrospective analysis had been accomplished of 92 patients with perihilar cholangiocarcinoma.Results The major symptoms were jaundice (97%,n=89),weight loss (39%,n=36),abdominal discomfort (33%,n=30) and pain (27%,n=25).According to Bismuth classification,there were 29% Ⅰ type (n=27),22%Ⅱ ( n=20),16% Ⅲ (n=15) and 33% IV (n=30)respectively.33% (n=30) patients caught postoperative complications and 3% (n=3) died,witth resection rate 39% (n=36),among those 53%(n=39) received radical resection.Distant metastasis (21%,n=21) and local widespread infiltration (62%,n=35),especially involvement of large vessels were the main reasons leading to unresectability.The median survival was 8 months,in those with tumor resection 25months and those without only 5 months (P<0.001,log-rank test).Conclusion Unresectable cholangiocarcinoma mainly accomplished with local infiltration or/and metastasis.Removal of tumor could prolong survival significantly.更多还原