Berdah S V, Delpero J R, Garcia S, Hardwigsen J, Le Treut Y P
Department of Digestive Surgery and Liver Transplantation, La Conception Hospital, Marseille, France.
Br J Surg. 1996 Nov;83(11):1517-21. doi: 10.1002/bjs.1800831108.
The aim of this retrospective study was to analyse outcome in 31 European patients operated on for peripheral cholangiocarcinoma between 1988 and 1995 (hilar cholangiocarcinoma was excluded). Before 1992, in addition to conventional resection, patients with irresectable tumour and with no extrahepatic metastasis underwent total hepatectomy with liver transplantation. Mild abdominal pain was the most frequent presenting clinical sign (11 of 31 patients) and jaundice was present in only four patients. Preoperative histological findings were available for 20 patients but the diagnosis was correct in only eight of these. Nineteen patients had curative surgery: 17 underwent conventional resection and two had total hepatectomy with liver transplantation. Major hepatectomy was performed in 12 of 17 cases, extended to the caudate lobe in five, to the bile duct confluence in four and to the retrohepatic vena cava in one. Postoperative mortality and morbidity rates were three and seven of 19 patients respectively, median survival was 15 months, and actuarial 1-, 2- and 5-year survival rates were 67, 40 and 32 per cent respectively. Twelve patients had only exploratory laparotomy because of the presence of extrahepatic metastasis or irresectable tumour. The invasive nature of peripheral cholangiocarcinoma can explain the limited number of resectable cases and the particularly unfavourable prognosis. Total hepatectomy does not provide survival benefit. Conventional surgery remains the only effective treatment, even for patients with advanced stage tumours.
本回顾性研究的目的是分析1988年至1995年间31例接受外周胆管癌手术的欧洲患者的治疗结果（肝门部胆管癌被排除）。1992年以前，除传统切除术外，肿瘤无法切除且无肝外转移的患者接受了肝移植全肝切除术。轻度腹痛是最常见的临床表现（31例患者中有11例），只有4例患者出现黄疸。20例患者有术前组织学检查结果，但其中只有8例诊断正确。19例患者接受了根治性手术：17例行传统切除术，2例行肝移植全肝切除术。17例中有12例进行了大肝切除术，其中5例扩大至尾状叶，4例至胆管汇合处，1例至肝后下腔静脉。19例患者的术后死亡率和发病率分别为3例和7例，中位生存期为15个月，1年、2年和5年的精算生存率分别为67%、40%和32%。12例患者因存在肝外转移或肿瘤无法切除仅接受了剖腹探查术。外周胆管癌的侵袭性可以解释可切除病例数量有限以及预后特别不良的原因。全肝切除术并不能提高生存率。即使对于晚期肿瘤患者，传统手术仍然是唯一有效的治疗方法。
