Shi Qian-Feng, Liang Ting-Bo, Qin Yun-Sheng, Wang Wei-Lin, Shen Yan, Zhang Min, Zheng Shu-Sen
Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
Hepatobiliary Pancreat Dis Int. 2007 Dec;6(6):622-6.
The incidence of extrahepatic cholangiocarcinoma increases in recent years. But the diagnosis and treatment are still troublesome to surgeons. This study was designed to explore the value of surgical approach in the treatment of extrahepatic cholangiocarcinoma.
We retrospectively analyzed the clinical data of 135 patients with extrahepatic cholangiocarcinoma who had been treated in our hospital from January 1992 to December 2006.
The ratio of extrahepatic cholangiocarcinoma to biliary duct diseases was 1.81%. The rates of total resection and radical resection were 70.75% (75/106) and 56.60% (60/106), respectively. The overall 1-, 3-, 5-year survival rates were 46.93%, 37.33% and 18.75%, respectively. The 1-, 3-, 5-year survival rates were better in the radical resection group (74.94%, 55.74% and 41.27%, respectively) than in the palliative resection group (42.86%, 26.79% and 26.79%, respectively) (P<0.05). The survival rates of patients who had undergone palliative resection were higher than those of patients who had been subjected to palliative drainage or non-operation: 1-, 3-, 5-year survival rates were 42.86%, 26.79%, 26.79% vs. 23.33%, 6.67%, 0 or 17.86%, 0, 0 (P<0.05). While the survival rates were not significantly different between palliative drainage and non-operation (P<0.05). Multivariate analysis revealed that the histopathological grades, TNM stages and modalities were key factors influencing the outcome.
The outcome of the patients with extrahepatic cholangiocarcinoma is still not optimistic. Radical resection is the first choice for the treatment of tumors.
近年来肝外胆管癌的发病率有所上升。但其诊断和治疗对外科医生来说仍然棘手。本研究旨在探讨手术方式在肝外胆管癌治疗中的价值。
我们回顾性分析了1992年1月至2006年12月期间在我院接受治疗的135例肝外胆管癌患者的临床资料。
肝外胆管癌与胆管疾病的比例为1.81%。根治性切除率和总切除率分别为70.75%（75/106）和56.60%（60/106）。1年、3年、5年总生存率分别为46.93%、37.33%和18.75%。根治性切除组的1年、3年、5年生存率（分别为74.94%、55.74%和41.27%）优于姑息性切除组（分别为42.86%、26.79%和26.79%）（P<0.05）。接受姑息性切除患者的生存率高于接受姑息性引流或未手术患者：1年、3年、5年生存率分别为42.86%、26.79%、26.79%，对比23.33%、6.67%、0或17.86%、0、0（P<0.05）。而姑息性引流和未手术之间的生存率无显著差异（P<0.05）。多因素分析显示，组织病理学分级、TNM分期和手术方式是影响预后的关键因素。
肝外胆管癌患者的预后仍不容乐观。根治性切除是肿瘤治疗的首选。
