Zhou Ning-xin, Huang Zhi-qiang, Zhang Wen-zhi, Huang Xiao-qiang, Wang Jing, Liu Rong, Ji Wen-bin, Xiao Mei, Meng Xiang-fei
Institutes of Hepatobiliary Surgery of Chinese People's Liberation Army, General Hospital of Chinese People's Liberation Army, Beijing 100853, China.
Zhonghua Wai Ke Za Zhi. 2006 Dec 1;44(23):1599-603.
To analyze clinical typing, pathologic characteristics of hilar cholangiocarcinoma (HCCA) and surgical strategies and their effects on HCCA, and to explore the factors that influence the surgical outcomes and long-term survival.
The data of the 402 patients with HCCA admitted between January 1993 and December 2004 was investigated retrospectively. Primary outcomes examined included clinical typing, pathologic characteristics, surgical procedures and follow-up results. On the basis of Bismuth-Corlette typing, we defined the tumor originated from intrahepatic large bile duct (LBD) as type V (type Va and Vb).
Among the 402 patients with HCCA, 198 cases accepted curative resection, 102 (51.5%) for radical resection and 96 (48.5%) for palliative resection. Of the rest patients, 8 received orthotopic liver transplantation (OLT), 161 received simple drainage and 35 were not operated on. The resection rates for type I, II, IIIa, IIIb, IV, Va and Vb were 69.4%, 55.5%, 57.4%, 71.7%, 19.6%, 100% and 34.6%, respectively. The one-year survival rates for radical resection, palliative resection, simple drainage and untreated were 80.3%, 53.2%, 26.7% and 9.8%, respectively. And the three-year and five-year survival rates in the four groups were 41.9% and 33.3%, 19.6% and 14.7%, 3.3% and 0, 0 and 0, respectively. Significant difference was found in survival rates between the radical and palliative resection. In the patients who received tumor resection, the ones without lymph nodes metastasis (LNM) survived much longer than those with LNM (P < 0.05). Complications were found in 36.1% of the patients and the mortality rate was 0.3%.
HCCA type V originated from intrahepatic LBD has higher resection rate and better prognosis. The tumor differentiation is significantly correlated with the prognosis after operation. With HCCA, resection is still the major treatment selection. Curative resection carries the best effect. Extended radical resection of liver lobes, blood vessels, lymph nodes can prolong survive. The problem of high recurrence rate after OLT for HCCA has not been solved yet.
分析肝门部胆管癌（HCCA）的临床分型、病理特征及手术策略及其对HCCA的影响，探讨影响手术疗效及长期生存的因素。
回顾性调查1993年1月至2004年12月收治的402例HCCA患者的数据。检查的主要结果包括临床分型、病理特征、手术方式及随访结果。在Bismuth-Corlette分型的基础上，将起源于肝内大胆管（LBD）的肿瘤定义为V型（Va型和Vb型）。
402例HCCA患者中，198例行根治性切除，其中根治性切除102例（51.5%），姑息性切除96例（48.5%）。其余患者中，8例行原位肝移植（OLT），161例行单纯引流，35例未手术。I型、II型、IIIa型、IIIb型、IV型、Va型和Vb型的切除率分别为69.4%、55.5%、57.4%、71.7%、19.6%、100%和34.6%。根治性切除、姑息性切除、单纯引流及未治疗患者的1年生存率分别为80.3%、53.2%、26.7%和9.8%。四组患者的3年和5年生存率分别为41.9%和33.3%、19.6%和14.7%、3.3%和0、0和0。根治性切除与姑息性切除的生存率差异有统计学意义。在接受肿瘤切除的患者中，无淋巴结转移（LNM）者的生存时间明显长于有LNM者（P<0.05）。36.1%的患者出现并发症，死亡率为0.3%。
起源于肝内LBD的V型HCCA切除率较高，预后较好。肿瘤分化程度与术后预后显著相关。对于HCCA，手术仍是主要的治疗选择。根治性切除效果最佳。扩大肝叶、血管、淋巴结的根治性切除可延长生存期。HCCA患者OLT后高复发率的问题尚未解决。
