Surgical Treatment of Hilar Cholangiocarcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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胡超华 , 胡若男 , 熊杰 , 胡少辉 , 沈雄山 , 李卫民 , 樊立

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Keywords：

胆管癌; 　外科治疗; 姑息性手术; 根治性手术; 　疗效

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目的探讨肝门部胆管癌2种手术方法的疗效。方法回顾性分析我院1998～2006年期间收治的37例肝门部胆管癌患者的临床资料。结果 37例患者中13例行根治性手术切除, 其1年与3年的生存率分别为100%（13/13）和76.92%（10/13），中位生存期为22.43个月；另24例行姑息性手术（均为肝内胆管内引流术），其1年与3年生存率分别为54.55%（12/22）和9.09%（2/22），中位生存期为15.42个月。结论根治性手术是治疗肝门部胆管癌的主要手段；姑息性手术，如合理的肝内胆管内引流能改善患者的生存质量。

Citation： 胡超华,胡若男,熊杰,胡少辉,沈雄山,李卫民,樊立. Surgical Treatment of Hilar Cholangiocarcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2009, 16(11): 873-874. doi: Copy

1.	刘永锋. 肝门部胆管癌的治疗现状 [Ｊ]. 中国实用外科杂志, 2000; 20(1): 28-31.
2.	Bismuth H, Nakache R, Diamond T. Management strategies in resection for hilar cholangiocarcinoma [Ｊ]. Ann Surg, 1992; 215(1): 31-38.
3.	何效东, 董家鸿, 赵晓雷, 等. 肝门部胆管癌的诊断与外科治疗 [Ｊ]. 中华肝胆外科杂志, 2008; 14(8): 582-584.
4.	秦锡虎, 朱峰, 段云飞, 等. 围肝门胆道手术方式方法的探讨附79例报告 [Ｊ]. 中华普外科手术学杂志(电子版), 2008; 2(3): 284-288.
5.	Clary B, Jarnigan W, Pitt H, et al. Hilar cholangiocarcinoma [Ｊ]. J Gastrointest Surg, 2004; 8(3): 298-302.
6.	梁力建. 重视肝门部胆管癌的诊断和治疗 [Ｊ]. 中国实用外科杂志, 2007; 27(5): 351-353.
7.	黄志强, 黄晓强主编. 肝胆胰外科聚焦 [M]. 第1版. 北京: 人民军医出版社, 2005: 338-350.
8.	Capussotti L, Muratore A, Polastri R, et al ，Liver resection for hilar cholangiocarcinoma: in-hospital mortality and longterm survival [Ｊ]. J Am Coll Surg, 2002; 195(5): 641-647.
9.	Tsao JI, Nimura Y, Kamiya J, et al. Management of hilar cholangiocarcinoma: comparison of an American and a Japanese experience [Ｊ]. Ann Surg, 2000; 232(2): 166-174.
10.	Jarnagin WR, Fong Y, DeMatteo RP, et al. Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma [Ｊ]. Ann Surg, 2001; 234(4): 507-517; discussion 517-519.
11.	姜洪池，陆朝阳. 肝门部胆管癌联合尾状叶根治性切除 [Ｊ]. 中国实用外科杂志, 2007; 27（5）： 364-366.
12.	黄志强. 肝门部胆管癌外科治疗的现状与展望 [Ｊ]. 中国普外基础与临床杂志, 2005; 12(4): 317-320.
13.	Kitagawa Y, Nagino M, Kamiya J, et al，Lymph node metastasis from hilar cholangiocarcinoma: audit of 110 patients who underwent regional and paraaortic node dissection [Ｊ]. Ann Surg, 2001; 233(3): 385-392.
14.	Burke EC, Jarnagin WR, Hochwald SN, et al. Hilar Cholangiocarcinoma: patterns of spread, the importance of hepatic resection for curative operation, and a presurgical clinical staging system [Ｊ]. Ann Surg, 1998; 228(3): 385-394.
15.	彭淑牖, 李江涛. 肝门部胆管癌的术式选择 [Ｊ]. 临床外科杂志, 2006; 14(2): 70-72.
16.	Ebata T, Nagino M, Kamiya J, et al. Hepatectomy with portal vein resection for hilar cholangiocarcinoma: audit of 52 consecutive cases [Ｊ]. Ann Surg, 2003; 238(5): 720-727.
17.	Kondo S, Nimura Y, Hayakawa N, et al. Extensive surgery for carcinoma of the gallbladder [Ｊ]. Br J Surg, 2002; 89(2): 179-184.
18.	周宁新, 黄志强, 张文智, 等. 402例肝门部胆管癌临床分型、手术方式与远期疗效的综合分析 [Ｊ]. 中华外科杂志, 2006; 44(23): 1599-1603.
19.	周宁新. 肝门部胆管癌扩大根治术及疗效评价 [Ｊ]. 中国普外基础与临床杂志, 2005; 12(4): 323-324.
20.	Inoue K, Makuuchi M, Takayama T, et al. Long-term survival and prognostic factors in the surgical treatment of mass-forming type cholangiocarcinoma [Ｊ] . Surgery, 2000; 127(5): 498-505.
21.	Kawasaki S, Imamura H, Kobayashi A, et al. Results of surgical resection for patients with hilar bile duct cancer: application of extended hepatectomy after biliary drainage and hemihepatic portal vein embolization [Ｊ]. Ann Surg, 2003; 238(1): 84-92.

1. 刘永锋. 肝门部胆管癌的治疗现状 [Ｊ]. 中国实用外科杂志, 2000; 20(1): 28-31.
2. Bismuth H, Nakache R, Diamond T. Management strategies in resection for hilar cholangiocarcinoma [Ｊ]. Ann Surg, 1992; 215(1): 31-38.
3. 何效东, 董家鸿, 赵晓雷, 等. 肝门部胆管癌的诊断与外科治疗 [Ｊ]. 中华肝胆外科杂志, 2008; 14(8): 582-584.
4. 秦锡虎, 朱峰, 段云飞, 等. 围肝门胆道手术方式方法的探讨附79例报告 [Ｊ]. 中华普外科手术学杂志(电子版), 2008; 2(3): 284-288.
5. Clary B, Jarnigan W, Pitt H, et al. Hilar cholangiocarcinoma [Ｊ]. J Gastrointest Surg, 2004; 8(3): 298-302.
6. 梁力建. 重视肝门部胆管癌的诊断和治疗 [Ｊ]. 中国实用外科杂志, 2007; 27(5): 351-353.
7. 黄志强, 黄晓强主编. 肝胆胰外科聚焦 [M]. 第1版. 北京: 人民军医出版社, 2005: 338-350.
8. Capussotti L, Muratore A, Polastri R, et al ，Liver resection for hilar cholangiocarcinoma: in-hospital mortality and longterm survival [Ｊ]. J Am Coll Surg, 2002; 195(5): 641-647.
9. Tsao JI, Nimura Y, Kamiya J, et al. Management of hilar cholangiocarcinoma: comparison of an American and a Japanese experience [Ｊ]. Ann Surg, 2000; 232(2): 166-174.
10. Jarnagin WR, Fong Y, DeMatteo RP, et al. Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma [Ｊ]. Ann Surg, 2001; 234(4): 507-517; discussion 517-519.
11. 姜洪池，陆朝阳. 肝门部胆管癌联合尾状叶根治性切除 [Ｊ]. 中国实用外科杂志, 2007; 27（5）： 364-366.
12. 黄志强. 肝门部胆管癌外科治疗的现状与展望 [Ｊ]. 中国普外基础与临床杂志, 2005; 12(4): 317-320.
13. Kitagawa Y, Nagino M, Kamiya J, et al，Lymph node metastasis from hilar cholangiocarcinoma: audit of 110 patients who underwent regional and paraaortic node dissection [Ｊ]. Ann Surg, 2001; 233(3): 385-392.
14. Burke EC, Jarnagin WR, Hochwald SN, et al. Hilar Cholangiocarcinoma: patterns of spread, the importance of hepatic resection for curative operation, and a presurgical clinical staging system [Ｊ]. Ann Surg, 1998; 228(3): 385-394.
15. 彭淑牖, 李江涛. 肝门部胆管癌的术式选择 [Ｊ]. 临床外科杂志, 2006; 14(2): 70-72.
16. Ebata T, Nagino M, Kamiya J, et al. Hepatectomy with portal vein resection for hilar cholangiocarcinoma: audit of 52 consecutive cases [Ｊ]. Ann Surg, 2003; 238(5): 720-727.
17. Kondo S, Nimura Y, Hayakawa N, et al. Extensive surgery for carcinoma of the gallbladder [Ｊ]. Br J Surg, 2002; 89(2): 179-184.
18. 周宁新, 黄志强, 张文智, 等. 402例肝门部胆管癌临床分型、手术方式与远期疗效的综合分析 [Ｊ]. 中华外科杂志, 2006; 44(23): 1599-1603.
19. 周宁新. 肝门部胆管癌扩大根治术及疗效评价 [Ｊ]. 中国普外基础与临床杂志, 2005; 12(4): 323-324.
20. Inoue K, Makuuchi M, Takayama T, et al. Long-term survival and prognostic factors in the surgical treatment of mass-forming type cholangiocarcinoma [Ｊ] . Surgery, 2000; 127(5): 498-505.
21. Kawasaki S, Imamura H, Kobayashi A, et al. Results of surgical resection for patients with hilar bile duct cancer: application of extended hepatectomy after biliary drainage and hemihepatic portal vein embolization [Ｊ]. Ann Surg, 2003; 238(1): 84-92.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Surgical Treatment of Hilar Cholangiocarcinoma

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