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目的探讨综合评分系统在肝门部胆管癌术前可切除性评估中应用的可行性。方法回顾性分析2005年1月至2013年10月收治的112例肝门部胆管癌患者的临床资料,分别对每例患者的胆红素水平、彩超、CT、MRI检查结果综合评分,按照评分系统进行术前可切除性的判断,并与手术结果进行比较。结果 112例患者均接受手术,其中根治性手术72例,姑息性手术32例,剖腹探查活检及内或外引流术8例。所有患者的术后病理诊断均为胆管腺癌。术中情况结合术后病理提示13例有肝动脉受侵,19例门静脉受侵,21例淋巴结转移,8例腹膜种植转移或远处转移。综合评分0~5分38例,R0切除(手术切缘无肿瘤细胞残存)36例(94.7%);6~10分35例,R0切除24例(68.6%);11~15分34例,R0切除12例(35.3%);16~18分5例R0切除0例。结论综合评分系统可为肝门部胆管癌患者提供良好的术前可切除性评估。
Objective To investigate the feasibility of comprehensive scoring system in the evaluation of preoperative resectability of hilar cholangiocarcinoma. Methods The clinical data of 112 patients with hilar cholangiocarcinoma admitted from January 2005 to October 2013 were retrospectively analyzed. The scores of bilirubin, color Doppler, CT and MRI in each patient were comprehensively scored. System to determine the preoperative resectability, and compared with the surgical results. Results All the 112 patients underwent surgery, of which 72 were radical surgery, 32 were palliative surgery, laparotomy biopsy and internal or external drainage were performed in 8 patients. Postoperative pathological diagnosis of all patients were cholangiocarcinoma. Intraoperative findings combined with postoperative pathology showed that 13 cases had hepatic artery involvement, 19 cases of portal vein invasion, 21 cases of lymph node metastasis and 8 cases of peritoneal implantation or distant metastasis. There were 36 cases (94.7%) with R0 resection (no residual tumor at the surgical margin) in 35 cases (6-10), 24 cases (68.6%) with R0 resection, 34 cases (11-15) R0 resection in 12 cases (35.3%); 16 to 18 points in 5 cases of R0 resection in 0 cases. Conclusion The comprehensive scoring system can provide a good preoperative resectability assessment for patients with hilar cholangiocarcinoma.