| 抄録 |
Objective：To outline our experience of surgical treatment of perihilar cholangiocarcinoma.
Patients：Between 1977 and 2010, a total of 755 patients with perihilar cholangiocarcinoma were treated at our clinic. In 181（24%）, tumor was unresectable because of advanced disease or poor general condition. The remaining 574 underwent resection of the tumor and were enrolled in this study. There were 381 men and 193 women, with an average age of 64±10 years. Of the 574 resected patients, 414（72%）were jaundiced on admission and underwent biliary drainage. After 1991, portal vein embolization was used in patients who were to undergo right hepatectomy or more extensive resections.
Surgery：Only 19（3%）patients underwent bile duct resection, and the remaining 555 underwent hepatectomy. Types of hepatectomy performed were：resection of S1+4-8 in 43 patients；resection of S1+5-8 in 177；resection of S1-5+8 in 110；resection of S1-4 in 187；and other segmentectomies in 38. Combined pancreatoduodenectomy was carried out in 74 patients（13%）, portal vein resection and reconstruction in 206（36%）, and hepatic artery resection and reconstruction in 76（13%）. R0 resection was achieved in 439（77%）patients. Mean operative time was 668±134 minutes, and intraoperative blood loss was 2491±2156 mL. Of the 574 resected patients, 27 died of postoperative complication. Thus, overall mortality was 4.7%；it decreased recently, being only 2.1%（8/386）after 2001.
Survival：Overall 3- and 5-year survival rates（including all deaths）were 44.6% and 33.1%. Survival for the 386 patients after 2001 improved significantly compared to that for the 188 patients before 2000（49.3% at 3 year and 40.0% at 5-year vs. 36.2 at 3-year and 23.1 at 5-year, P＜0.0001）.
Conclusions： Hepatectomy for perihilar cholangiocarcinoma is performed safely with acceptable mortality. Aggressive resectional approach can offer a better chance of long-term survival in selected patients. |
