Clinical efficacy of combined hemihepatectomy for hilar cholangiocarcinoma

彭沙沙; 黄汉飞; 段键; 林杰; 代敏; 张艺; 曾仲

doi:10.3969/j.issn.1007-3969.2014.06.009

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Clinical efficacy of combined hemihepatectomy for hilar cholangiocarcinoma

更新时间：2025-12-31

- Clinical efficacy of combined hemihepatectomy for hilar cholangiocarcinoma
- China Oncology Vol. 24, Issue 6, Pages: 451-456(2014)
- 作者机构：
  
  1. 昆明医科大学第一附属医院器官移植中心,云南,昆明,650032
  2. 昆明医科大学护理学院,云南,昆明,650031
- 作者简介：
- 基金信息：
- DOI：10.3969/j.issn.1007-3969.2014.06.009
  CLC：
- Published Online：29 July 2014，
  
  Published：29 July 2014
- 稿件说明：
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彭沙沙,黄汉飞,段键,林杰,代敏,张艺,曾仲. 联合肝叶切除治疗肝门部胆管癌的疗效分析[J]. 中国癌症杂志, 2014, 24(6): 451-456.

彭沙沙, 黄汉飞, 段键, et al. Clinical efficacy of combined hemihepatectomy for hilar cholangiocarcinoma[J]. China Oncology, 2014, 24(6): 451-456.
彭沙沙,黄汉飞,段键,林杰,代敏,张艺,曾仲. 联合肝叶切除治疗肝门部胆管癌的疗效分析[J]. 中国癌症杂志, 2014, 24(6): 451-456. DOI： 10.3969/j.issn.1007-3969.2014.06.009.

彭沙沙, 黄汉飞, 段键, et al. Clinical efficacy of combined hemihepatectomy for hilar cholangiocarcinoma[J]. China Oncology, 2014, 24(6): 451-456. DOI： 10.3969/j.issn.1007-3969.2014.06.009.

摘要

背景与目的：肝门部胆管癌(hilar cholangiocarcinoma，HC)侵袭途径广泛以及术后缺乏有效辅助治疗，目前患者获得治愈的惟一途径依然是手术根治性切除。术前可切除性评估、术前胆道引流、肝切除的范围及淋巴结清扫范围等问题一直是研究的热点。本文探讨联合肝叶切除治疗HC的临床经验及疗效。方法：回顾性分析昆明医科大学第一附属医院2007年1月—2013年10月行手术治疗的207例HC患者的临床及随访资料。结果：全组207例患者中，125例行根治性切除(R

切除)，R

切除率为60.4%。联合肝叶切除156例，肝叶切除组获R0切除率70.5%；51例行单纯性切除，单纯性切除组获R

切除率29.4%，两组比较R

切除率差异有统计学意义(P0.01)。2例患者死于围手术期，术后主要并发症包括肝肾功能不全和胆漏。获得随访的172例中，102例行R

切除的患者中位生存时间为45个月，术后1、3、5年累积生存率分别为96.1%、59.1%、17.2%，70例行R

1-2

切除的患者中位生存时间为26个月，术后1、3年累积生存率分别为81.3%、19.2%，无5年存活患者。获得R

切除患者术后生存率优于姑息性切除(R

1-2

切除)患者，差异有统计学意义(χ

=39.121，P0.01)。在联合肝叶切除组中获R

切除患者术后1、3、5年生存率为97.8%、63.9%、18.0%，在单纯性切除组中获R

切除患者术后1、3、5年生存率为83.3%、20.8%、8.3%，两组术后生存率差异有统计学意义(χ

=5.988，P=0.014)。结论：根治性切除是提高HC远期疗效的关键，联合肝叶切除及标准化淋巴结清扫可显著提高HC的根治性切除率及远期疗效。

Abstract

Background and purpose: Because of the aggressive nature of hilar cholangiocarcinoma and the absence of effective adjuvant therapy

surgical radical resection offers hilar cholangiocarcinoma patients the only choice. Research focus include preoperative assessment

the use of preoperative biliary drainage

the range of hepatic resection

and the range of lymphadenectomy. To investig

ate the clinical experience and efficacy of combined hepatectomy in the treatment of hilar cholangiocarcinoma. Methods: Two hundred and seven patients with hilar cholangiocarcinoma treated surgically in the First Affiliated Hospital of Kunming Medical University form Jan. 2007 to Oct. 2013 were retrospectively analyzed. Results: Of the 207 patients

125 patients who received radical resection (R

resection) and the curative resection rate was 60.4%. One hundred and fifty-six cases were treated in combined hepatectomy group

51 cases in non-hepatectomy group

the rate of R

resection was 70.5% in hepatectomy group and 29.4% in non-hepatectomy group

and the difference was significant (P0.01). Two patients died perioperatively

the main postoperative complications included hepatic function insufficiency and bile leakage. One hundred and seventy- two patients were followed up

the median survival time of the 102 patients who received R

resection was 45 months

and the 1

5 year survival rates were 96.1%

59.1% and 17.2%. The median survival time of the 70 patients who received R

1-2

resection was 26 months

and the 1

3 year survival rates were 81.3% and 19.2%

and none of the patient survived for over 5 years. The survival rate of patients who received R0 resection was significantly higher than those who received R1-2 resection (χ

=39.121

P0.01). In the hepatectomy group was awarded the R

resection in patients with postoperative 1

5 year survival rate was 97.8%

63.9% and 18.0%

in non-hepatectomy group received R

resection in patients with postoperative 1

5 year survival rate was 83.3%

20.8% and 8.3%. There were significant differences in the postoperative survival rate between both group (χ

=5.988

P=0.014). Conclusion: Radical excision is the key to improve the long term survival. Combined hemihepatectomy and standardized lymph node resection has significantly improved the radical resection rate and the efficac

y of treatment for hilar cholangiocarcinoma.

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