Miyazaki M, Ito H, Nakagawa K, Ambiru S, Shimizu H, Shimizu Y, Kato A, Nakamura S, Omoto H, Nakajima N, Kimura F, Suwa T
First Department of Surgery, School of Medicine, Chiba University, Japan.
Surgery. 1998 Feb;123(2):131-6.
It has been reported that surgical excision of hilar cholangiocarcinoma rather than palliative surgical therapy, chemotherapy, or radiotherapy caused prolonged survival in some patients, However, excision is associated with high operative morbidity and mortality rates, particularly when hepatic resection is also performed. The aim of this study was to evaluate the clinical implications of hepatic resection in hilar cholangiocarcinoma.
The study involved 76 patients with hilar cholangiocarcinoma who were undergoing surgical resections. Twenty-one patients (28%) underwent a combined resection, with reconstruction of the portal vein in 20 patients and reconstruction of the hepatic artery in 7 patients. Sixty-five patients undergoing seven different types of hepatic resection with extrahepatic bile duct resection (BDR) and 11 patients undergoing BDR only were retrospectively compared for background, operative morbidity and mortality, and survival.
Curative resection was obtained in 5 of 11 (45%) patients undergoing local resection and in 49 of 65 (75%) patients undergoing hepatic resection (p < 0.05). The surgical morbidity rates were 34% and 27% for hepatic and local resection, respectively. The 30-day mortality and hospital mortality rates were 4.6% and 15% for hepatic resection and 0% and 0% for local resection, respectively. The 5-year survival rate was 26% for all resected patients (76 patients); it was 40% versus 0% for curative versus noncurative resections (p < 0.05). No significant difference in surgical resection rates was revealed between hepatic and local resection among resected and curative resected patients.
Aggressive surgical approaches to obtain curative resections could bring about a better prognosis in hilar cholangiocarcinoma independently of whether hepatic resection or local resection is performed.
据报道，肝门部胆管癌手术切除而非姑息性手术治疗、化疗或放疗可使部分患者生存期延长。然而，手术切除与高手术发病率和死亡率相关，尤其是在同时进行肝切除时。本研究的目的是评估肝切除在肝门部胆管癌中的临床意义。
本研究纳入76例行手术切除的肝门部胆管癌患者。21例（28%）患者接受了联合切除，其中20例患者进行了门静脉重建，7例患者进行了肝动脉重建。回顾性比较65例接受七种不同类型肝切除加肝外胆管切除（BDR）的患者和11例仅接受BDR的患者的背景、手术发病率和死亡率以及生存率。
11例接受局部切除的患者中有5例（45%）获得根治性切除，65例接受肝切除的患者中有49例（75%）获得根治性切除（p<0.05）。肝切除和局部切除的手术发病率分别为34%和27%。肝切除的30天死亡率和医院死亡率分别为4.6%和15%，局部切除的分别为0%和0%。所有切除患者（76例）的5年生存率为26%；根治性切除与非根治性切除的5年生存率分别为40%和0%（p<0.05）。在切除患者和根治性切除患者中，肝切除和局部切除的手术切除率无显著差异。
积极采取手术方法以获得根治性切除可使肝门部胆管癌患者获得更好的预后，无论进行肝切除还是局部切除。
