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3 2 56% 58.4% 5 11% 31% 30% 50% 5% 16%~40% PTCD

4 (R 0 ) 50 (R 1 R 2 ) % 59.55% 40.23% 24.76% % 8.77% 4.38% 4.38% % 37.31% % 51.04% 36.46% 25.52% % 22.41% 12.80% 6.40% (R 0 ) (R 1 R 2 ) PTCD 3

5 Surgical treatment and prognosis analysis of 142 cases of hilar cholangiocarcinoma Postgraduate: Jirong Shi Teacher: Professor Jianxun Zhao Department of surgery The first hospital of Peking University Abstract Objective: To compare the effect on prognosis of several kinds of surgical treatment of hilar cholangiocarcinoma. Methods: Clinical data of 142 patients with hilar cholangiocarcinoma treated surgically in our hospital from 1983 to 2003 were analyzed retrospectively. Results: The 142 patients were grouped according to the different kinds of surgical treatment. 103 patients were divided in the resection group; the other 39 patients were divided in the drainage group. In the resection group, the 1,2,3,5-year survival rates were 90.61%, 59.55%, 40.23%, 24.76% and 49.60%, 8.77%, 4.38%, 4.38% in radical and palliative resection subgroups, respectively. In the drainage group, the 1-year survival rate was 26.00% in laparotomized and 37.31% in nonlaparotomized drainage subgroups. None in the patients of the drainage group survived for over 2 years. In the resection group, the 1, 2, 3, 5-year survival rates of the patients underwent hepatectomy were 87.43%, 51.04%, 36.46% and 25.52%. Meanwhile, the 1, 2, 3, 5-year survival rates of the patients not underwent hepatectomy were 55.82%, 22.41%, 12.80% and 6.40%. Conclusion: Exact preoperative evaluation of resectability, choosing a rational surgical procedure, using a rational 4

6 approach of hepatectomy is the key to prolong postoperative survival period of hilar cholangiocarcinoma. Exploring laparotomy must be performed in all patients while there were no obvious contraindications or evidence of extrahepatic spread. Radical resection is the best method in all kinds of surgical treatment correspondingly. In the laparotomy, palliative resection is better than simple bypass operation. Internal drainage with biliary stent is better than PTCD in the non-operative treatment. Key words: Hilar cholangiocarcinoma Surgical treatment Prognosis Radical resection 5

7 (Hilar cholangiocarcinoma HCC) 1965 Klatskin [1] klatskin (Klatskin tumor) 56% 58.4% % 31% 4 12, 70 DNA Sato (60%) 12 DNA (P<0.01) DNA DNA ras ras ras 15 ras 0% 100%

8 K-ras 41% 22 K-ras Nuria K-ras K-ras K ras 1.7 K ras 7.7 K ras K ras 7 8 K ras ras P21 21KD Voravud P21 75%(47 63) P21 Nonomura P %(39/44) P21 P21 ras H rasp21 H rasp21 H rasp21 H rasp21 C-erB-2 C-erB-2 src 17q21 P Voravud C-erB-2P %(46 63) ( ) Chow 26 P 185 Motojima P 185 7

9 P 185 P C-erB-2 C-erB-2 C-erB-2 C-myc myc C-myc 13 C-myc 29 Voravud C-mycP 62 94%(59 63) ( ) C-myc APC DCC APC 5q21 300KD ras DCC 5q APC DCC Storto 32 5 Ding 33 (LOH) 5q q35-qter q35-qter (30%) APC DCC 5 5q21 22 p53 p53 8

10 p53 34 p53 p53 p53 [35] Kiba 36 PCR SSCP 38 p53 34%(13/38) Ohashi p53 19%(4/21) p53 Teh [37] SP 18 p %(10/18) 50%(5/10) Roncalli 38 p p %(16/50) p53 (P<0.05) p53 p53 p53 p53 (P<0.05) p53 p21 WAF1 p21 WAF1 CDKS( ) p53 34 Dergham 39 p21 WAF % 30 p21 WAF1 36.7%(11 30) p21 WAF1 p21 WAF1 p21 WAF1 (p<0.05) p21 WAF1 9

11 nm23 nm23 Steeg 40 nm23 nm Fujii nm %(20/63) nm23 nm23 nm23 nm nm23 35% nm23 CD44v6 CD44 (CD44s) (CD44v) v 47 v6 CD44 48 Gunthert 49 CD44v6 50 CD44v6 46 CD44v6 63%(29/46) CD44v6 TNM CD44v6 CD44v6 CD44v6 10

12 (TNM ) CD44v6 Ki-67 Ki-67 DNA G 1 G 2 M S G 2 M G 0 Ki Ki-67 Ki-67 Ki-67 Ki-67 Ki-67 Ki-67 ras erb-2 myc p53 p21 WAF1 nm23 CD44v6 Ki-67 11

13 54,, 40% 9% 36% 55 Rosen (7%) Blumgart Falchuk (26%) 5% 10% % 28% %

14 55 54/10 2/10 (carcinoembryonic antigen, CEA) CEA Nakeeb 61 CEA CEA CEA(50.2±5.8ng/ml) (1±3.9ng/ml) CEA Tsuji CEA 30 (cytokeratin) Maeda CK7 97% 7% CK19 77% 0% CK20 10% 0% Rullier 64 CK7 CK20 13

15 CK7+/CK20- CK7+/CK20+ CA19-9 CA19-9 Patel 65 CA19-9 CA19-9>100U ml 53% 24% 8% CA19-9 CA19-9 CA CA19-9 (CCRA) CCRA IgG CEA AFP β 2 MG [67] CCRA CCRA % B CT B CT Gibson B 9.5% CT 90% B 88% CT 63% B 91% CT 42% B B 14

16 69 70 B B [71] (CDUS) B B 72 B <1cm 73 CT CT CT B CT CT ( ) CT <1.5cm 75 Choi B 21% CT 40% 76 CT 15

5-25袁宏钧.indd

5-25袁宏钧.indd 第 24 卷第 5 期 2015 年 5 月碘 131 doi:10.3978/j.issn.1005-6947.2015.05.005 http://dx.doi.org/10.3978/j.issn.1005-6947.2015.05.005 Chinese Journal of General Surgery, 2015, 24(5):643 647. Chinese Journal of