摘要目的 探讨肝门部胆管癌的手术疗效及影响其预后的因素.方法 回顾性分析中国医科大学附属第一医院1996年1月至2007年5月收治的204例肝门部胆管癌的临床资料,并进行多因素Cox回归模型预后因素分析.结果 204例按Bismuth-Corlette分型:Ⅰ型18例,Ⅱ型40例,Ⅲa型30例,Ⅲb型53例,Ⅳ型57例.其余6例未分型.术前行彩超、CT检查和MRCP检查与术中Bismuth分型对照,诊断符合率分别为53.7%、76.4%、100%.手术切除肿瘤92例,其中根治性切除(R0)55例,姑息性切除(R1、R2)37例.胆道探查置管引流98例,开腹探查6例,同种异体原位肝移植手术2例.手术切除组和非手术切除组生存率差异有统计学意义(x2=36.4,P<0.01),根治性切除组和姑息性切除组生存率差异有统计学意义(X2=22.9,P<0.05).Cox模型多因素分析表明手术方式、肿瘤细胞分化程度是二个独立的预后因素.结论 肝门部胆管癌的治疗以手术切除为主,只有根治性切除才能达到最佳疗效.

abstractsObjective To investigate the surgical effect of hilar cholangiocarcinoma and its impact on prognosis. Method The clinical data of 204 hilar cholangiocarcinoma admitted into the First Hospital of China Medical University were retrospectively analyzed. According to the Bismuth-corlette type, type Ⅰ was 18 cases, type Ⅱ 40 cases, type Ⅲ-a 30 cases, type Ⅲ-b 53 cases, type Ⅳ 57 cases. The other 6 cases was not typed. Color Doppler ultrasound, CT, MRCP were used to determine the Bismuth-Corlette type before the surgery. Based on preoperative image diagnosis the correct diagnosis rate was 53. 7%, 76. 4%, 100% for ultrasound, CT and MRCP respectively. Ninety-two cases underwent tumor resection, including radical resection (R0) in 55 cases, and palliative resection (R1, R2) in 37 cases. Ninety-eight cases underwent exploration and biliary drainage, 6 cases did laparotomy only, 2 cases received liver transplantation. The survival rate (P < 0. 001) is statistically different between patients receiving tumor resection and those not. Radical resection and palliative resection group are also statistically different in survival rates (P < 0. 05). Cox multivariate analysis shows that operation pattern, histological differentiation are two independent prognostic factors. Conclusion Surgery is the main method to treat hilar cholangiocarcinoma and radical resection could achieve the best effect. Reasonable perioperative treatment could reduce the complications and mortality.