| Background and Purpose:Bile duct cancer is one kind of rare cancer, account for 3% of gastrointestinal tract tumour all, 5 000 example patients increases newly every year in USA, incidence is (1-2)/100,000; Incidence of our country rises with the speed of 5% increasing by degrees every year, is that the gastrointestinal tumour is hit by the quickest one kind of tumour of ascensional velocity. Liver outside bile duct cancer (extrahepatic cholangiocarcinoma, EHCC) according to having the spot to divide into the up-side, the center-side, and lower segement three part, among them up-side bile duct cancer is also called hepatic portal bile duct cancer, take up a sum 40%~60%. Operations of EHCC includs bile duct excision, gallbladder excision, hepatic portal or liver dodecadactylon ligamentum lymph node cleaning (namly skeleton-rization), and bile duct jejunum anastomosis, also including liver excision and the pancreas duodenum excision, liver transplantation to cure bile duct cancers appears to the news report in recent years. That disease early phase diagnose is comparatively difficult, operation excision rate is low, the prognosis is bad, specially the hepatic portal bile duct cancer, the surgery treats the difficulty to be big, investigates whose cause having two:(1) The pathological change spot's particularity as well as the tumor wetting quality grow the characteristic, causes the tumor the surgery excision rate to be very low, the radical cure excision is achieves with difficulty; (2) Cuts the reason for the surgery to remain without the cancer cell, needs to perform the union internal organs excision frequently, but"the liver gate department bile duct cancer widespread excision method obtains the advantage often and the high surgery mortality rate counter-balances by its high complication rate".Therefore, enhances outside the liver the bile duct malignant tumor diagnosing and treating level important aspect is at present the early time discovered that the early diagnosis, the early treatment as well as the improvement surgery method, the enhancement permanent control excision rate, cuts the complication formation rate, but"safely expands the excision the liver gate department bile duct cancer is the present research direction".Method: Review analysis in January, 2004 - January, 2008 Jilin University first hospital courage surgical department admitting altogether 176 example EHCC patient's clinical material. The discussion understands at present outside our hosptial liver the bile duct malignant tumor patient's diagnosis, the treatment present situation, the lessons learned, thus raises the bile duct cancer's diagnosing and treating level. Uses the method which the telephone and the outpatient service revisit unifies to carry on the revisit. Statistics processing uses the SPSS17.0 software, according to a data type line ofχ2 examination; the survival rate computation uses the Kaplan-Meier law, and makes the log-rank examination. By P < 0.05 have statistics significance for the difference.Result: The group of 60~70 year-old patients who suffered bile duct cancer are most, the male is more than the female, the male and female ratio is 1.44:1; The upside bile duct cancer sees more, accounts for 48.9%, next is the lower segment cancer, accounts for 43.7%; the B-ultrasonography is the bile duct cancer phantom study diagnosis first choice inspection accounts for 84.7%, the diagnosis accuracy is 79.2% (118/149), the CT inspection accounts for 72.7% (128/176), the diagnosis accuracy is 85.9% (109/128), MRI unifies the MRCP inspection to account for 33.5% (59/176), the diagnosis accuracy is 100% (59/59). After the surgery, the pathology result demonstrates in the bile duct cancer the high split up cancer to account for 48.5%, low splits up the cancer to account for more than 50%. The bile duct cancer is one kind of old age masculine patient's common malignant digestive tract tumor, the bile duct cancer's radical cure excision rate 33.0% (58/176) compares the first more than 10 years to improve some extent, specially, the upside bile duct cancer's radical cure excision rate 53.4% (31/58) obviously increases, (the Chinese Medical Association in 1990 surgery branch obviously counting bile duct cancer operation excision rate being 18.0%, the upside and center-side is 10.4%). But the liver gate department bile duct cancer's treatment had still not made the breakthrough progress yet. In this group of 176 examples patient, obtains the complete revisit material 153 examples, the revisit rate 86.9%. 153 example patient's overall 1, 3, 5 years survival rate respectively is 51.9%, 26.7% and 10.8%. And the radical cure excision group (58 examples) 1, 3, 5 years survival rate respectively is 74.3%, 41.6% and 20.7%; Appeases the excision group (6 examples) 1, 3, 5 years survival rate respectively is 50.3%, 7.6% and 0%; The drainage group (89 examples) 1 year survival rate is 31.8%, does not have 3 year survival. The radical cure excision group survival rate is higher than appeases the excision group and the drainage, the difference has statistics significance (X2=7.38, P=0.025<0.05).Conclusion: Bile duct cancer is that old age male sex is easy to send out a disease, is fond of sending out an age group for 60-70-year-old. The ultrasound is the first choice inspection way before the operation of bile duct cancer, MRI+MRCP has the important clinical value in the diagnosis of the bile duct cancer (specially liver gate bile duct cancer), and in the preoperative classification and assessment of respectability. The liver gate bile duct cancer classification, the near-end bile duct to infiltrate the depth, the hepatic artery, the portal vein whether infringed, whether there is the lymph node and the distant place shift and the surgery technology affect the important attribute which the liver gate bile duct cancer excises. The bile duct cancer effective method of treatment is the radical cure excision, but appeases the surgery to be possible to lengthen the patient lifetime obviously.
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