【作者】 李炳才；

【导师】 张炳远；

【作者基本信息】 青岛大学 ， 外科学， 2008， 硕士

【摘要】 【目的】:比较不同治疗方法对肝门胆管癌预后的影响【方法】:随访并回顾性研究我院2000年1月—2005年4月共108例肝门胆管癌病人,根治性切除R0标准为切缘镜下无癌,切缘镜下可见癌细胞定为R1切除,切缘肉眼肿瘤组织定为R2切除,开腹引流包括开腹T型管和姑息性胆肠吻合术,非开腹包括的PTBD和支架治疗。预后观察起始点为:开腹手术日期或单纯经皮经肝胆道引流日期。观察终点为:死亡日期或本研究最后随访时间(2007年12月)。统计处理采用spss13.0软件进行统计处理,并比较各种治疗方法与生存率的关系。【结果】:2000/1—2005/4病人肝门胆管癌共108例,根治性切除率33.3%(36/108),非根治性切除率36.1%(39/108)(R1,R2)例,引流组中开腹引流14例,非开腹19例接受肿瘤切除的病人生存期明显长于引流组(P＜0.01),其中根治切除的病人有着更高的生存率(P＜0.01)。【结论】:手术方式是肝门胆管癌最重要的预后因素,在开腹手术中,根治性切除(R0)的效果最佳,非根治性切除(R1,R2)的效果要优于单纯旁路手术。开腹引流术与非开腹引流生存期无明显差异。更多还原

【Abstract】 【objetive】:compare the effect of therapeutics methods to prognosis of hilar cholangiocarcinoma.【Method】:a retrospective clinical analysiswas performed on the clinical data from 108 patients with hilar cholangiocarcinoma from jan 2000 to apr 2005.the standard of radical excision is non-cancer with microscope at incised margin or it can be classified as R1.the standard of R2 is that the remain of tumor can be found with naked eyes.laparotomized drainage include T-type pipe drainage and chole- intestinal anastomosis,non-laparotomized drainage include PTBD and biliary endoprosthesisThe time to initiate follow-up is the date of surgery.the end point is date of death or the last date of investigationStatistics:dispose the data with spss13.0 to compare the all kinds of therapy to HCC.【result】:108 patients with hilar cholangiocarcinoma surgically treated in our hospital from jan 2000 to may 2003.the rate of radical resection is 33.3%(36/108),the the rate of palliative resection is36.1%(39/108)(R1,R2) In the drainage group 14 patients undergoing laparotomized drainage and 19 patients undergoing non-laparotomized respectively.The survival of patients with resection was longer than that of drainage group. among of them the patients with radical resection possess higher survival rate【Conclusion】:the method of therapy is the most important factor to prognosis.The effect of radical excision is best among laparotomized operation.The effect of palliative resection is better than that of simple by-pass operation.there is no obvious difference between the survival of laparotomized and non-laparotomized drainage更多还原