| Objective:Through a retrospective study of the clinical data of patients with hilar cholangiocarcinoma,the surgical methods,perioperative complications and mortality of 64 patients with hilar cholangiocarcinoma were analyzed,so as to explore the reasonable surgical treatment plan for patients with hilar cholangiocarcinoma,which is conducive to reducing the complication rate and improving the 3-year and 5-year survival rates。Methods:The clinical data and follow-up results of 64 patients diagnosed with hilar cholangiocarcinoma and undergoing surgical treatment in the east hospital of the fourth hospital of Hebei medical university from January 2015 to December 2019 were retrospectively analyzed to summarize the surgical methods,complications and mortality of hilar cholangiocarcinoma,and observe the 3-year and 5-year postoperative survival rates of the patients.The effect of surgical treatment of hilar cholangiocarcinoma was analyzed.Results: Among the 64 patients,45 were males and 19 were females,with a male-to-female ratio of 2.37∶1.The minimum age was 26 years old,the maximum age was 74 years old,and the average age was 67 years old.The surgical resection rate was 87.5%(56/64),and the palliative drainage rate was 12.5%(8/64).Postoperative pathological results showed that 40 cases of adenocarcinoma and 16 cases of bile duct cell carcinoma were diagnosed.1.The total postoperative complication rate and 1-month mortality were 12.5% and 0%,respectively,in the local resection group of hilar cholangiocarcinoma,and 43.8% and 3.1%,respectively,in the combined hemihepatectomy group or combined hemihepatectomy group and caudate-lobectomy group.2.TNM staging in 56 patients with surgical resection,R0 resection Ⅰ period 100.0%(7/7),phase Ⅱ R0 resection rate 67.7%(21/31),phase Ⅲ A ～ C R0 resection rate 64.2%(9/14),ⅣA ～ B period R0 resection rate 25.0%(1/4).Hepatic bile duct carcinoma TNM staging portal vein ⅣA ～ B period of surgery in patients with R0 resection rate is lower than Ⅰ stage,stage Ⅱ and Ⅲ A ～ C.3.Bismuth typein 56 patients with surgically resected parting,hepatic cholangiocarcinoma partial portal vein resection group type Ⅰ R0 resection was 71.4%(5/7),type Ⅱ R0 resection rate was 0%,(0/4),ⅢA ～ B type R0 resection rate was 9.1%(1/11),type Ⅳ R0 resection rate was 0%,Combined liver or joint half liver caudate lobe resection group and type Ⅰ R0 resection rate was 100.0%(9/9),type Ⅱ R0 resection rate was 100%,(5/5),ⅢA ～ B type R0 resection rate was 100.0%(19/19),type Ⅳ R0 resection rate was 77.8%(7/9).Hepatic bile duct Bismuth classification of portal vein Ⅰ,ⅡⅢA ～ B type and Ⅳ patients choose joint half liver or joint and R0 resection of liver caudate lobe resection and higher than local excision of R0 resection rate.4.The R0 resection rate was 25.0%(6/24)in the local resection group of hilar cholangiocarcinoma,and 93.6%(30/32)in the hilar cholangiocarcinoma combined with hemihepatectomy or hemihepatectomy and caudate-lobectomy group.5.The 3-year survival rates of the R0 resection group,R1R2 resection group and palliative drainage group were 77.0%,44.4% and 18.8%,respectively;the 5-year survival rates of the R0 resection group,R1R2 resection group and palliative drainage group were 51.3%,14.8% and 0%,respectively.The 3-year and 5-year survival rates of the R0 resection group were significantly higher than that of the R1R2 resection group and the palliative drainage group.Conclusion: The R0 resection rate of the combined hemihepatectomy group or the combined hemihepatectomy group and caudate lobectomy group was significantly higher than that of the local resection group.Although the complication rate and mortality rate were higher than that of the local resection group,it was still a safe and effective operative method,and the 3-year and 5-year survival rates were significantly higher than that of the local resection group and the palliative drainage group. |
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