目的　总结作者应用肝部分切除联合肝十二指肠骨髂化治疗肝门部胆管癌的临床经验。方法　回顾 1999年 1月～ 2 0 0 1年 12月住院手术探查病人 6 7例的临床资料。结果　 6 7例中 6 5例手术切除。 49例根治性切除 ( 2 2例肝十二指肠韧带骨髂化切除 ,2 7例联合部分肝切除 )。 6例病人行根治性切除手术 ,术后病理切缘阳性而归为姑息切除。根据Bismuth分型 ,Ⅰ、Ⅱ型行骨髂化切除 ,Ⅲ、Ⅳ型联合各种肝切除。Ⅲa型行右半肝 +右尾叶切除 ,Ⅲb左半肝 +左尾叶 ,Ⅳ型中行右半肝 +全尾叶 3例 ,左半肝 +全尾叶 9例 ,方叶切除者 2例。 2例外院行部分肿瘤切除 +肝门胆管空肠吻合术者 ,我们再次行左半肝 +全尾叶切除 +右肝管空肠吻合术根治肿瘤。 8例病人行肿瘤部分切除 +肝内胆管支撑 +肝门胆管空肠吻合。 13例病人 ( 2 0 % )行门脉部分切除 ,2 7例病人切除肝动脉。 2 4例病人术后无并发症发生 ,2 3例并发症较轻 ,2 0例发生了严重并发症。 14例经治疗后康复 ,余 6例病人术后 7、12、14、42、5 7、89天死于肝功能衰竭、心源性休克、腹内大出血、消化道大出血。 30天死亡率 4.5 % ,根治性手术后病人平均生存期 16个月 ( 1～ 32个月 ) ,姑息治疗者为 7个月 ( 1～ 14个月 )。结论　肝部分切除联合肝十二指肠韧带骨髂化可用 Objective To summarize the clinical experience of the authors in the treatment of hilar cholangiocarcinoma with partial hepatectomy combined with hepatoduodenal iliac fibrosis. Methods The clinical data of 67 cases hospitalized in January 1999 to December 2001 were retrospectively reviewed. Results 6 out of 67 cases were surgically removed. Forty-nine patients underwent radical resection (resection of 22 cases of hepatoduodenal ligament osteotomy, 27 cases of partial hepatectomy). Six patients underwent radical resection surgery, pathologically positive margins and classified as palliative resection. According to Bismuth classification, type I and type II osteotomy ilioidectomy, type III and type IV combined with various hepatectomy. Ⅲ a type right right lobe and right caudate lobe resection, Ⅲ b left lobe and left caudate lobe, type Ⅳ right lobe and right caudal lobe in 3 cases, left lobe and whole caudate lobe in 9 cases, square lobectomy in 2 cases . 2 exception, part of the hospital tumor excision + hilar cholangiojejunostomy, we once again line the left half of the liver + whole caudate lobectomy + right hepaticojejunostomy to cure the tumor. 8 patients underwent partial tumor resection + intrahepatic biliary support + hilar cholangiojejunostomy. Thirteen patients (20%) underwent partial portal resection and 27 patients underwent hepatic artery resection. Twenty-four patients had no complication after operation, 23 patients had less complications, and 20 patients had serious complications. 14 cases recovered after treatment, and 6 cases died of hepatic failure, cardiogenic shock, intra-abdominal hemorrhage and gastrointestinal bleeding at 7, 12, 14, 42, 57 and 89 days after operation. The 30-day mortality rate was 4.5%. The mean survival time of patients after radical surgery was 16 months (range, 1 to 32 months) and palliative treatment was 7 months (range, 1 to 14 months). Conclusions Partial hepatectomy and hepatoduodenal ligament osteolysis are available