Kusano T, Tamai O, Miyazato H, Isa T, Shiraishi M, Muto Y, Furukawa M
First Department of Surgery, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan.
Int Surg. 1998 Apr-Jun;83(2):119-23.
The surgical management of proximal bile duct carcinoma is controversial. There is no consensus among surgeons as to the indications for radical resection. This article described personal experience with the different surgical procedures for patients with proximal bile duct carcinoma.
The medical records of fifty-two consecutive patients undergoing surgical resection over a 20-year period were retrospectively analysed in terms of pathology, perioperative mortality, clinical course, and overall survival.
The 1-, 3- and 5-year survivals for the entire group were 63.3%, 24.5%, and 21.0%, respectively. The results for local resection of the extrahepatic bile duct in 35 cases were unsatisfactory. Radical resection that included the right extended hepatic lobe, caudate lobe, and extrahepatic bile duct was performed in 9 patients and demonstrated an excellent 5 year survival rate of 44.4%. However, hospital mortality was 22.2%. There was no significant difference among the operative procedures for patients with advanced disease.
Radical resection remains the procedure of choice in proximal bile duct carcinoma. However, results with surgical therapy alone remain unsatisfactory. Multimodality treatment that also includes radiotherapy and/or chemotherapy is recommended.
肝门部胆管癌的外科治疗存在争议。对于根治性切除的指征，外科医生之间尚无共识。本文介绍了肝门部胆管癌患者不同手术方式的个人经验。
回顾性分析20年间连续接受手术切除的52例患者的病历，内容包括病理、围手术期死亡率、临床病程和总生存期。
全组患者1年、3年和5年生存率分别为63.3%、24.5%和21.0%。35例肝外胆管局部切除的结果不尽人意。9例患者行包括右肝扩大叶、尾状叶和肝外胆管的根治性切除，5年生存率高达44.4%，但医院死亡率为22.2%。晚期疾病患者的手术方式之间无显著差异。
根治性切除仍是肝门部胆管癌的首选手术方式。然而，单纯手术治疗的效果仍不尽人意。建议采用包括放疗和（或）化疗的多模式治疗。
