Geng Xiao-ping, Zhu Hua-gang, Liu Fu-bao, Hou Hui, Zhang Zhi-gong, Zhao Hong-chuan, Wang Guo-bin, Zhao Yi-jun
Department of General Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230032, China.
Zhonghua Wai Ke Za Zhi. 2009 Aug 1;47(15):1167-70.
To analyze the clinical data, surgical strategies and results from the patients with hilar cholangiocarcinoma (HCCA), and to explore the anatomic factors related to the radical resection.
The data from 52 patients with HCCA who underwent radical resection between January 1984 to December 2008 were investigated retrospectively, which included clinical diagnosis, Bismuth-Corlette classification, pathologic features, surgical procedures and follow-up results.
According to the Bismuth-Corlette classification, 5, 12, 6, 16 and 13 patients belonged to type I, II, IIIa, IIIb and IV respectively. There were 24 cases underwent combined hepatic lobectomy. The 1-, 3- and 5-year survival rates were 78.8%, 36.4% and 12.1% respectively. Postoperative complications rate was 30.8% with the 3.8% mortality rate. The frequency of surgical complications was significantly higher in patients with higher level of serum total bilirubin (> 340 micromol/L) than that in patients with a relatively lower one (170 micromol/L) before operation (P < 0.05).
Some anatomical factors should be considered during the radical resection of hilar cholangiocarcinoma, especially evaluation of potential hepatectomy, resection of caudate lobe, hepatic artery resection and/or reconstruction. The prognosis of the patients underwent R(0) radial resection could be significantly improved.
分析肝门部胆管癌（HCCA）患者的临床资料、手术策略及结果，探讨与根治性切除相关的解剖学因素。
回顾性研究1984年1月至2008年12月期间52例行根治性切除的HCCA患者的数据，包括临床诊断、Bismuth-Corlette分型、病理特征、手术方式及随访结果。
根据Bismuth-Corlette分型，I型、II型、IIIa型、IIIb型和IV型分别有5例、12例、6例、16例和13例。24例行联合肝叶切除术。1年、3年和5年生存率分别为78.8%、36.4%和12.1%。术后并发症发生率为30.8%，死亡率为3.8%。术前血清总胆红素水平较高（>340μmol/L）的患者手术并发症发生率显著高于相对较低（<170μmol/L）的患者（P<0.05）。
肝门部胆管癌根治性切除时应考虑一些解剖学因素，尤其是潜在肝切除术、尾状叶切除、肝动脉切除和/或重建的评估。行R(0)根治性切除患者的预后可显著改善。
