老年肝门胆管癌的围手术期处理

【】目的探讨老年肝门胆管癌的围手术期处理方法。方法回顾性分析1992年6月-2004年10月收治的60岁以上的肝门胆管癌患者临床资料。结果78例患者合并有多脏器储备功能改变，施行手术切除12例，外引流手术11例，内引流手术55例。17例出现并发症，以肺部感染、肝肾功能衰竭和吻合口瘘为多见。根治性切除、姑息性切除和姑息性引流组手术后中位生存时间分别为12、8、5个月。结论肝门胆管癌的手术复杂，创伤大，对老年患者更容易产生心肺功能异常及各种并发症；但通过围手术期内合理、充分的综合治疗措施，仍能取得较好的治疗效果。？【Abstract】ObjectiveToinvestigatetheperioperativetherapyfortheelderpatientswithhilarcholangiocarcinoma.MethodsTheclinicaldataofover60yearsoldpatientswithhilarcholangiocarcinomawhoweretreatedinthehospitalfromJune1992toOctober2004wereretrospectivelyanalyzed.ResultSeventy-eightpatientswithmultipleorgansliverfunctionalchanges,12patientsreceivedsurgicalexcision,11patientsreceivedexternaldrainagesurgery,55patientsreceivedinternaldrainagesurgery.Postoperativecomplicationsoccurredin17patients,wostofwhichwerelunginfection,liverandkidneyfailureandanastomoticleakage.Themediansurvivaltimewere12,eightandfivemonthsforthepatientswhoreceivedradicalresection,palliativeresectionanddrainage,respectively.ConclusionsThesurgicaltreatmentforhilarcholangiocarcinomaiscomplicatedwithmajorsurgicaltrauma.Thepostoperativecomplicationandthecardio-pulmonarydysfunetionareeasilyhappenedespeciallyintheagedpatients.Intensivesupportivetherapyisneededalloverthecourse.