目的 规范肝门部胆管癌整块或根治性切除术的手术方式，改进和提高其手术治疗效果。 方法 总结分析了解放军总医院1986年至1999年手术治疗的肝门部胆管癌157例资料。 结果 总手术切除率为67.5%（106/157），根治性切除率为37.6%（59/157）。近3年对54例肝门部胆管癌行手术切除，切除率为74%（41/54）,根治性切除率为43%（23/54）；随访3年存活率：根治性切除组为57%(13/23),姑息性切除组为41%(7/17),未切除组为7% (1/14)。 结论 术中病理诊断是选择根治性切除术的重要参考指标。%Objective To evaluate a newly designed radical resection for hilar cholangiocarcinoma in terms of higher resection rate and longer survival. Methods A retrospective analysis was made on 157 patients undergoing radical operation for hilar cholangiocarcinoma from 1986 to 1999. Results The total resection rate and the radical resection rate was 67.5% (106/157) and 37.6% (59/157), respectively, whereas among 54 cases undergoing surgery during recent 3 years it was 74% (41/54) and 43% (23/54) respectively. The 3-year survival rate of radical resection，palliative resection and non-resection was 57% (13/23)，41% (7/17) and 7% (1/14). Conclusion Intraoperative pathological diagnosis plays an important role in the selection of radical resection. The improvements of radical resection of hilar cholangiocarcinoma are as follows: (1) transection of proximal hepatic bile duct at the porta hepatis; (2) skeletoning the portal vein combined with resection of the hepatica propria artery; (3) excision of portal vein plus hemihepatectomy; (4) cholangiojejunostomy without internal stent.
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