Baer H U, Stain S C, Dennison A R, Eggers B, Blumgart L H
Clinic for Visceral and Transplantation Surgery, University of Berne, Switzerland.
Ann Surg. 1993 Jan;217(1):20-7. doi: 10.1097/00000658-199301000-00005.
The operative management of hilar cholangiocarcinoma has evolved because of advances in diagnostic imaging that have permitted improved patient selection, and refinements in operative techniques that have lowered operative mortality rates. Over a 4-year period, 48 patients with hilar cholangiocarcinoma were managed. Twenty-seven patients were treated by palliative measures. Preoperative investigation identified 29 patients who were judged fit for operation without proven irresectability by radiologic studies, and 21 of the 29 patients had tumor removal (72%). Twenty-three operative procedures were performed: local excision (n = 12) (two had subsequent hepatic resection), and hepatic resection primarily (n = 9). Eight patients had complications (35%), and one patient died (4.3%). The mean actuarial survival after local excision in 36 months, and after hepatic resection, 32 months. Palliation as assessed by personal interview was excellent for more than 75% of the months of survival. A combination of careful patient selection and complete radiologic assessment will allow an increased proportion of patients to be resected by complex operative procedures with low mortality rate, acceptable morbidity rate, and an increase in survival with an improved quality of life.
由于诊断性影像学的进展使得患者选择得到改善，以及手术技术的改进降低了手术死亡率，肝门部胆管癌的手术治疗方法不断演变。在4年期间，对48例肝门部胆管癌患者进行了治疗。27例患者接受了姑息治疗。术前检查确定了29例经放射学检查判断适合手术且未证实无法切除的患者，其中21例（72%）接受了肿瘤切除。共进行了23例手术：局部切除（n = 12）（其中2例随后进行了肝切除），主要为肝切除（n = 9）。8例患者出现并发症（35%），1例患者死亡（4.3%）。局部切除后的平均精算生存率为36个月，肝切除后为32个月。通过个人访谈评估，超过75%的生存月数的姑息治疗效果良好。仔细的患者选择和全面的放射学评估相结合，将使更多患者能够通过复杂的手术进行切除，手术死亡率低，发病率可接受，生存率提高，生活质量改善。
