目的 探讨经手术切除肝门胆管癌（hepatichilarcholangocarcinoma,HHCC）手术切缘有无残癌对预后的影响。 方法 比较切缘有残癌组(43例)和无残癌组(40例)患者的临床分型、手术方式、肿瘤分化程度及生存情况。 结果 切缘有残癌组患者1、2、3和5年生存率，分别为37.2%、6.3%、3.5%和2.4%；切缘无残癌组患者分别为82.2%、58.2%、41.6%和27.7%。 结论 手术切缘残癌率与肿瘤分化程度关系密切，在BismuthⅣ型中发生率最高。BismuthⅣ型中的低分化型腺癌患者，手术切除疗效差，对无肝外转移者可以选择肝移植术。%Objective To review 83 resected hilar cholangiocarcinomas, andanalyse the factors causing residual tumors at resection margins and the influence to survival rate. Methods Bismuth′s classification, surgical procedures,tumor differentiation, and survival time were compared between the positive or negative group at resection margins. Results The 1-,2-,3- and 5-year survival rates of the positive group (43 patients) were 37.2%,6.3%,3.5% and 2.4%, respectively, while those of the negative group (40 patients) was 82.2%,58.2%,41.6% and 27.7%. Conclusions There was a significant relationship between the rate of residual tumor margins and tumor differentiation; the highest rate of residual tumor was observed in Bismuth Ⅳ. The patients with lower differentiation in Bismuth Ⅳ have a poor prognosis for surgical resection; but there is no evidence of extrahepatic spread, and liver transplantation liver is feasible.
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