探讨肝门部胆管癌患者外科治疗的临床疗效。

回顾性分析2002年1月至2008年12月在上海交通大学附属第一人民医院外科收治的92例肝门部胆管癌患者临床资料。其中男48例，女44例；年龄（64±12）岁。所有患者均签署知情同意书，符合医学伦理学规定。92例患者中行肿瘤切除术35例，包括根治性切除术21例，姑息性切除术14例；行减黄术6例；行介入治疗43例，包括经内镜下逆行性胰胆管造影术（ERCP）胆道内引流41例和经皮经肝胆道引流术（PTCD）2例；行剖腹探查术8例。患者出院后接受随访，根据随访结果，记录患者的生存情况，绘制Kaplan-Meier生存曲线。不同外科治疗方法的生存分析与比较采用Kaplan-Meier法和Log-rank检验。

92例患者中84例随访资料完整，随访率为91%（84/92）。随访时间为2个月至3.5年，中位随访时间为26个月。肿瘤切除术患者中位生存期为22个月，其中根治性切除术患者为25个月，姑息性切除术患者为10个月；减黄术患者为14个月；介入治疗患者为9个月；剖腹探查术患者为4.5个月。肿瘤切除术、减黄术、介入治疗、剖腹探查术患者的生存率比较，差异有统计学意义（χ²=17.46，P<0.05）。肿瘤切除术患者的生存率明显高于介入治疗和剖腹探查术患者，差异有统计学意义（χ²=13.76，15.38；P<0.05）。根治性切除术患者的生存率明显高于姑息性切除术患者，差异有统计学意义（χ²=17.25，P<0.05）。

肝门部胆管癌患者外科治疗方法包括肿瘤切除术（根治性切除术、姑息性切除术）、减黄术、介入治疗及剖腹探查术等，其中肿瘤切除术可能有较好的临床疗效。

To evaluate the clinical efficacy of surgical treatments for patients with hilar cholangiocarcinoma.

Clinical data of 92 patients with hilar cholangiocarcinoma in Department of Surgery, Shanghai First People′s Hospital, Jiaotong University from January 2002 to December 2008 were studied retrospectively. There were 48 males and 44 females with mean age of(64±12) years old. The informed consents of all patients were obtained and the ethical committee approval was received. Thirty-five patients underwent tumor resection, including 21 cases of radical resection, 14 cases of palliative resection, 6 cases of jaundice-reducing operation and 43 cases of interventional therapy [41 cases of endoscopic retrograde cholangiopancreatography(ERCP) and 2 cases of percutaneous transhepatic cholangial drainage(PTCD)], and 8 cases of exploratory laparotomy. All the patients were followed up after being discharged from the hospital. The survival of patients were recorded according to the follow-up data and Kaplan-Meier survival curves were drawn. The survival of patients with different surgical treatments were analyzed and compared using Kaplan-Meier method and Log-rank test.

Complete follow-up data were obtained in 84 patients with the follow-up rate of 91% (84/92). The follow-up duration was from 2 months to 3.5 years with median of 26 months. The median survival time of patients with tumor resection was 22 months, which was 25 months for patients with radical resection, 10 months for patients with palliative resection. The median survival time of patients with jaundice-reducing operation, interventional therapy, exploratory laparotomy were 14, 9, 4.5 months respectively. There was significant difference among the 4 surgical treatments(χ²=17.46, P<0.05). The survival rate of patients with tumor resection was significantly higher than that of patients with interventional therapy and exploratory laparotomy. There was significant difference between two treatments(χ²=13.76, 15.38; P<0.05). The survival rate of patients with radical resection was significantly higher than that of patients with palliative resection. There was significant difference between two treatments (χ²=17.25, P<0.05).

The surgical treatment for patients with hilar cholangiocarcinoma includes tumor resection (radical resection and palliative resection), jaundice-reducing operation, interventional therapy and exploratory laparotomy. Tumor resection may be the optimal choice to achieve better curative effect.