探讨经皮经胆道引流（PTCD）术前减黄在肝门部胆管癌半肝切除中的应用价值。

回顾性分析2008年1月至2013年1月陆军军医大学第一附属医院行半肝联合尾状叶切除的78例肝门部胆管癌患者临床资料。患者均签署知情同意书，符合医学伦理规定。根据是否行PTCD术前减黄分为PTCD组和非PTCD组。PTCD组57例，男34例，女23例；平均年龄（57±9）岁。非PTCD组21例，男12例，女9例；年龄（54±6）岁。两组患者TB、手术时间比较采用t检验，率的比较采用χ²检验，生存分析采用Kaplan-Meier法和Log-rank检验。

PTCD组入院时TB为（295±131）μmol/L，明显高于非PTCD组的（137±37）μmol/L（t=3.768，P<0.05）；而PTCD后TB降为（67±25） μmol/L，明显低于非PTCD组（t=-5.784，P<0.05）。PTCD相关并发症发生率16%（9/57），其中胆管炎发生率12%（7/57），出血和种植转移发生率均为2%（1/57）。PTCD组、非PTCD组手术时间分别为（490±153）、（488±93）min，差异无统计学意义（t=0.040，P>0.05）。PTCD组输血率、R0切除率、并发症发生率分别为79%、79%、42%，与非PTCD组的71%、86%、38%相比，差异无统计学意义（χ²=0.157，0.122，0.102；P>0.05）。两组术后均无发生肝衰竭和死亡。两组总体生存率和无瘤生存率比较差异无统计学意义（χ²=1.469，1.384；P>0.05）。

PTCD应用于肝门部胆管癌术前减黄可明显降低胆红素水平，并不增加半肝切除手术风险，是安全、有效的，也不影响切除术后远期存活。

To evaluate the value of percutaneous transhepatic cholangial drainage (PTCD) before partial hepatectomy of hepatic hilar cholangiocarcinoma.

Clinical data of 78 patients with hepatic hilar cholangiocarcinoma who underwent partial hepatectomy combined with caudate lobectomy in the First Hospital Affiliated to Army Medical University between January 2008 and January 2013 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. According to whether preoperative PTCD was performed, patients were divided into the PTCD group (n=57) and non-PTCD group (n=21). In PTCD group, 34 patients were males and 23 were females, aged (57±9) years on average. In non-PTCD group, 12 cases were males and 9 werefemales, aged (54±6) years on average. Total bilirubin (TB) levels and operative time were compared between two groups using t test. The comparison of rates was performed using Chi-square test. Survival analysis was performed using Kaplan-Meier method and Log-rank test.

Upon admission, the TB level in PTCD group was (295±131) μmol/L, which was significantly higher than (137±37) μmol/L in non-PTCD group (t=3.768, P<0.05). TB level decreased to (67±25) μmol/L after PTCD, significantly lower than that in non-PTCD group (t=-5.784, P<0.05). The incidence of PTCD-related complications was 16%(9/57), where cholangitis was 12%(7/57), bleeding 2%(1/57) and implantation metastasis 2%(1/57). The operation time in the PTCD and non-PTCD groups was (490±153) and (488±93) min respectively, where no significant difference was observed (t=0.040, P>0.05). In PTCD group, the blood transfusion rate, R0 resection rate, and incidence of complications were 79%, 79% and 42% respectively, compared with 71%, 86% and 38% in non-PTCD group, where no significant difference was observed (χ²=0.157, 0.122, 0.102; P>0.05). No liver failure or death occurred in both groups. There was no significant difference in the overall survival and disease-free survival between two groups (χ²=1.469, 1.384; P>0.05).

It is safe and effective to apply PTCD before partial hepatectomy of hepatic hilar cholangiocarcinoma, which can significantly reduce the TB level, while does not increase the risk of surgery and does not affect the postoperative long-term survival.