Liu C L, Fan S T, Lo C M, Tso W K, Lam C M, Wong J
Centre for the Study of Liver Disease and Department of Surgery, University of Hong Kong, Hong Kong, China.
Br J Surg. 2006 Dec;93(12):1488-94. doi: 10.1002/bjs.5482.
The aim of the present study was to assess whether an aggressive surgical approach in the management of patients with hilar cholangiocarcinoma was associated with improved operative and survival outcomes.
Eighty-two patients with hilar cholangiocarcinoma treated between 1989 and 1998 (period 1), and 60 patients treated between 1999 and 2004 (period 2), were evaluated. Modifications to management in period 2 primarily included percutaneous biliary drainage instead of endoscopic drainage for relief of obstructive jaundice, preoperative right portal vein embolization before right-sided hepatectomy, routine total caudate lobectomy and radical lymphadenectomy during surgical resection of the tumour.
The surgical resection rate was significantly higher in period 2 than in period 1 (45 versus 16 per cent; P < 0.001). All patients in period 2 underwent major hepatectomy with concomitant caudate lobectomy. The operative morbidity and hospital mortality rates decreased significantly in period 2 compared with period 1, with significantly better survival outcomes. In multivariate analysis, resection of the tumour in period 2 and operative blood loss of 1.5 litres or less were the significant independent factors associated with improved survival.
An aggressive surgical approach was associated with improved operative and survival outcomes for patients with hilar cholangiocarcinoma.
本研究的目的是评估在肝门部胆管癌患者的治疗中采用积极的手术方法是否与改善手术及生存结果相关。
对1989年至1998年期间（第1阶段）治疗的82例肝门部胆管癌患者以及1999年至2004年期间（第2阶段）治疗的60例患者进行了评估。第2阶段治疗方法的改进主要包括采用经皮胆道引流而非内镜引流来缓解梗阻性黄疸，在右侧肝切除术前进行术前右门静脉栓塞，在肿瘤手术切除期间常规进行全尾状叶切除和根治性淋巴结清扫。
第2阶段的手术切除率显著高于第1阶段（45%对16%；P<0.001）。第2阶段的所有患者均接受了伴有尾状叶切除的大肝切除术。与第1阶段相比，第2阶段的手术发病率和医院死亡率显著降低，生存结果明显更好。在多变量分析中，第2阶段的肿瘤切除和手术失血量1.5升或更少是与生存改善相关的显著独立因素。
积极的手术方法与肝门部胆管癌患者改善手术及生存结果相关。
