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1、華中科技大學博士學位論文肝外膽管癌的實驗與臨床研究姓名：陳筠申請學位級別：博士專業(yè)：外科學（普外）指導教師：陳孝平20040401華中科技大學同濟醫(yī)學院博士學位論文THEEXPERIMENTALANDCLINICALSTUDYOFEXTRAHEPATICCHOLANGIOCARCINOMAABSTRACTCarcinomaofbileductisthemostfrequentmalignanttumorinbiliarysystem.W

2、ithaproportionof58to7“apercentofcarcinomaofbilehilarbileduetcancerwasalsocalledKlatskintumorfromKlatskidsoriginaldescriptionin1965.Inrecent30yearswiththedevelopmentandelevationofimageologydiagnostictechiquethecasesofextr

3、ahepaticcholan戀locarefnomahavebeenincreased卿勿year.Thedetectionrateofextrahepatiecholan您iocareinomainautopsyis0.01to0.5percentoverseaswithaproportionof2percentoftotalmalignanttumors.Inourcountrythedetectionrateis0.07to0.3

4、percent.IotheUnitedStatesapproximately7500newcasesofbiliarytractcanceraredia亡nosedperyearandamongthem2000to3000areaextrahepatfccholaugiocareinoma.Inourcountryananalysisof1098cholangiocarcinomacaseshasbeenreportedin1989an

5、d826areextrahepaticehol叫iocarcinoma咖apropotionof75.2percent.Atpresentsurgeryistheon妙effectivetreatmentforextrahepatictholangiccarcinoma.Althoughwiththeimprovementofoperationmethodexairesisrateelevatedunceasin心琢longtermef

6、fectivenessisstillnotoptimistic.Itwasreportedthatthesurvivalrateof5yearsisonly5to13percentineuropeamericancountries.Animportantfactortoaffectthelongtermeffectivenessiscomplicatonespeciallybiliaryfistulawhichisconcernedwi

7、thnotonlyindividualfeaturesandoncobiologycharatersbutalsoconcernedwithoperationmethod.Weusedthewayofretrospectivecaseanalysistostudytheeffectofanewcholangiojejunostomyinhilarbileductcancertopreventbiliaryfistula.Theresul

8、tsindicatedthattheoecrrencerateofbiliaryfistulaisdecreasedobviously.1ltrahepaticchol叫l(wèi)ocareinomaisnotsensitivetoradiotherapyandchemotherapyandchemotherapeutiesfrequentlyusedis5FUADMMMC.Itwasreportedthateffectisavailablei

9、nonly10to20percentofextrahepaticcholangiocarcinomacases.Chemolherapeuticsresistanceisoneofthemainreasonsresultingintheclinicalchemotherapeutic[allure.Thisresistancecouldbeeitherintrinsicoracquiredanditisrelatedtoexpressi

10、onofseveraldrugresistanceassociatedproteins.Differenttypeo[tumorstreatedwithdifferentdrugsmanifestedvariedmechanismofresistance.Studyin哈theexpressionofmultidrugresistanceassociatedproteinsishelpfulforselectin惑theproperre

11、gimenofchemotherapyforffndin戀methodtoavoidorreverseresistanceforimprovingtheefficiencyoftreamentPresen你themechanismsofthemutidrugresistanceintumorsaremainlyinvolvedindrugdetoxicationthealterationofdru必targetsandmembranep

12、roteio.Therewere儷reportsonmultidrugresistanceofextrahepaticcholan套focarcinomawedetectedtheexpressionofseveraldrugresistanceassociatedproteinsand叔resultsindicatedthatthepositiveexpressionratesofMDR1hitCSTn，TopIlaand淤inext

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