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肝门部胆管癌切除率很低,作者在1991年前收治17例中仅切除1例,切除率5.9%。此后,采用了附加肝叶的扩大切除,9例病人切除4例,切除率为44.4%,较前明显提高。本组无围术期死亡,存活期明显延长。作者强调B超在诊断上的重要作用。对梗阻性黄疸鉴别诊断时要充分考虑该病的可能性。主张早期手术,认为术前PTBD弊多利少。作者改进了胆肠吻合的缝合方法,避免了吻合口胆漏,同时指出提高切除率的另一关键是施术者的决心和经验。应多争取一期切除。
The resection rate of hilar cholangiocarcinoma is very low. The authors removed only 1 of 17 cases before 1991, and the resection rate was 5.9%. Since then, an extended resection of the attached hepatic lobe has been used. In 9 patients, 4 cases were removed and the resection rate was 44.4%, which was significantly higher than before. There was no perioperative death in this group and the survival period was significantly longer. The author emphasizes the important role of ultrasound in diagnosis. The differential diagnosis of obstructive jaundice should fully consider the possibility of the disease. Advocating early surgery, that preoperative PTBD more harm than good. The authors improved the suturing method of biliary-enteric anastomosis to avoid bile leakage at the anastomosis, and pointed out that another key to improving the resection rate is the surgeon’s determination and experience. More efforts should be made to remove the disease.