Wagner H E, Ballmer F T, Blumgart L H
Universitätsklinik für viszerale Chirurgie, Inselspital, Bern.
Schweiz Med Wochenschr. 1987 Dec 26;117(52):2104-12.
Hilar cholangiocarcinoma is relatively rare. Typically it spreads locally, the main manifestation being painless jaundice. Exact preoperative staging includes sonography or CT scan, cholangiography, angiography and aspiration cytology. This assessment should delineate the tumor extent and provide an excellent index of tumors which are clearly unresectable. Therapy has two objectives: firstly, if possible, to eliminate the tumor, and secondly, to restore bile flow. Resection of hilar cholangiocarcinoma can be accomplished in some 20% of cases with a 30 day hospital mortality close to zero for local excision and of approximately 10% for hepatic resections. The median time resected patients remain alive is 24 months, and the 5 year survival rate of resected patients is 12%. The mortality rate for palliative relief of biliary obstruction by any method in hilar cholangiocarcinoma is reported at 16-30%. Survival after intubation averages only 3 to 6 months and for surgical bypass about 8 months.
肝门部胆管癌相对少见。通常它会局部扩散，主要表现为无痛性黄疸。准确的术前分期包括超声检查或CT扫描、胆管造影、血管造影和穿刺细胞学检查。这种评估应明确肿瘤范围，并为明显无法切除的肿瘤提供一个很好的指标。治疗有两个目标：第一，如果可能，消除肿瘤；第二，恢复胆汁流动。约20%的肝门部胆管癌病例可进行切除，局部切除的30天医院死亡率接近零，肝切除的死亡率约为10%。接受切除的患者的中位生存时间为24个月，接受切除的患者的5年生存率为12%。据报道，通过任何方法对肝门部胆管癌进行姑息性胆道梗阻缓解的死亡率为16% - 30%。插管后的平均生存期仅为3至6个月，手术旁路的生存期约为8个月。
