【摘要】 目的探讨肝外胆管癌的临床诊断和外科治疗效果。方法回顾性分析肿瘤外科收治的136例肝外胆管癌患者的临床资料。结果根治性切除(A组,42例)、姑息性切除(B组,17例)、非切除性手术组(C组,77例)的临床症状、症状持续时间和实验室检查无显著性差异。A组术前准确诊断率62%(2642),显著低于B组的94%(1617)(P=0.014)和C组的87%(6777)(P=0.002);A组肿瘤直径为2.52±0.15cm,与B组(2.53±0.26cm)接近,均显著小于C组(3.92±0.23cm)(P均<0.001)。35例(26%)出现手术并发症,手术死亡率4%(6例),B组术后感染率(35%,617)显著低于C组(23%,1877)(P=0.006)。A组中位生存25.0±5.4个月,5年生存率27%(415);B组中位生存13.0±4.1个月,没有5年生存;C组术后中位生存只有6.0±0.6个月(A组或B组对比C组,P均<0.001)。结论肝外胆管癌的早期临床诊断能力不足。只有获得阴性切缘的患者才能获得长期生存。更多还原

【Abstract】 Objective To investigate the preoperative diagnosis and surgical effect of extrahepatic cholangiocarcinoma.Methods A retrospective analysis had been accomplished of 136 patients with extrahepatic cholangiocarcinoma.Results There were no significant differences in clinical symptoms,the complaint persistant period and laboratory examinations among patients with extrahepatic cholangiocarcinoma who underwent radical resection(group A,n=47),non-radical ones(group B,n=17)and non-resection operations(group C,n=77).The preoperative imagine diagnostic accurate was lower in group A(62%,26/42)than Group B(94%,16/17)(P=0.014)or C(87%,67/77,P=0.002).The same mean tumor size of group A(2.52±0.15cm)and group B(2.53±0.26cm)was smaller than Group C(3.92±0.23cm)(P<0.001)also.The morbidity and mortality rate was 26%(n=35)and 4%(n=6)respectively.The postoperative infection was predisposed in group B(35%,6/17)than in group C(23%,18/77)(P=0.006).The median survival of group A was 25.0±5.4 months,with 27% actual 5-year survival.The median survival period of group B was up to 13.0±4.1 months,but there was no 5-year survivor.The median survival of group C was only 6.0±0.6 months,worse than group A and B respectively(P<0.001).Conclusions The accurate rate of preoperative diagnosis on early-staged extrahepatic cholangiocarcinoma was insufficient yet now.Only those who received negative resection margin could get long survival.更多还原