探讨肝门部胆管癌的外科治疗及疗效。

回顾性分析1999年6月至2009年6月在青岛大学医学院附属医院行外科治疗的113例肝门部胆管癌患者临床资料。所有患者均签署知情同意书，符合医学伦理学规定。其中男55例，女58例；年龄37～70岁，中位年龄61岁。入院后患者接受全面的体检，常规行肝功能、肿瘤标志物及影像学检查。外科治疗方法包括根治性切除术、姑息性切除术、内引流术和外引流术。术后患者接受随访，观察患者手术、死亡和并发症发生情况。生存分析采用Kaplan-Meier法和Log-rank检验。

患者肝门部胆管癌Bismuth-Corlette分型Ⅰ型22例，Ⅱ型13例，Ⅲa型21例，Ⅲb型18例，Ⅳ型39例。患者手术切除率72.6%（82/113），其中根治性切除术53例，姑息性切除术29例；内引流术19例，外引流术12例。术后患者发生死亡3例，其中死于肝衰竭2例，死于上消化道出血1例。术后患者出现上消化道出血3例，肝性脑病5例，胆漏18例，腹腔感染3例，胸腔积液11例，切口感染及裂开7例。根治性切除术患者1、3、5累积生存率分别为76%、39%、11%，姑息性切除术患者相应为74%、21%、4%，内引流术患者为35%、2%、0，外引流术患者为28%、0、0，4种手术方式患者的生存率比较差异有统计学意义（χ²=21.367，P<0.05）。

对于肝门部胆管癌患者，术前完善评估并选择合适的手术方式有助于改善患者预后，提高生存率。

To explore the surgical treatments and the efficacy of hilar cholangiocarcinoma.

Clinical data of 113 patients with hilar cholangiocarcinoma in District of Huangdao, the Affiliated Hospital of Medical College Qingdao University from June 1999 to June 2009 were studied retrospectively. The informed consents of all patients were obtained and the ethical committee approval had been received. There were 55 males and 58 females with age ranging from 37 to 70 years old and a median age of 61 years old. After admitted in hospital, the patients underwent a comprehensive medical examination and received routine tests of liver function, tumor markers and imaging examinations. The surgical treatments included radical resection, palliative resection, internal drainage and external drainage. The patients were followed up after operation. The operation, death and incidence of complications were observed. Survival analysis were conducted using Kaplan-Meier method and Log-rank test.

There were 22 cases with hilar cholangiocarcinoma of Bismuth-Corlette typeⅠ, 13 cases type Ⅱ, 21 cases type Ⅲa, 18 cases type Ⅲb, 39 cases type Ⅳ. The surgical resection rate was 72.6% (82/113), including radical resection (n=53), palliative resection (n=29), internal drainage (n=19), external drainage (n=12). Three cases died after operation, including 2 cases died of liver failure, 1 case died of upper gastrointestinal bleeding. After operation, upper gastrointestinal bleeding were observed in 3 cases, hepatic encephalopathy in 5 cases, bile leakage in 18 cases, abdominal infection in 3 cases, pleural effusion in 11 cases, wound infection and dehiscence in 7 cases. The 1-, 3-, 5-year cumulative survival rate were 76%, 39%, 11% respectively for patients of radical resection, 74%, 21%, 4% for palliative resection, 35%, 2%, 0 for internal drainage, and 28%, 0, 0 for external drainage. There were significant differences in the survival rates for patients of 4 surgical treatments (χ²=21.367, P<0.05).

Improvement of preoperative evaluation and selection of appropriate surgical approach help to improve the outcome and survival rate of patients with hilar cholangiocarcinoma.