肝外胆管癌临床病理特征与预后的关系  

Clinicopathologic features and prognosis of extrahepatic cholangiocarcinoma

作　　者：秦兴雷[1] 王作仁[1] 鲁敏[2] 张云锋[1] 马炜[1] 杨平林[1] 

机构地区：[1]西安交通大学第一医院肝胆外科,陕西西安710061 [2]重庆医科大学第一医院血液科,重庆400016

出　　处：《第四军医大学学报》2005年第5期434-437,共4页Journal of the Fourth Military Medical University

摘　　要：目的:探讨肝外胆管癌(EHCC)临床病理特征与预 后的关系.方法:对1995 01/2003 12收治的128例EHCC患 者的临床病理特征、手术方式和随访结果进行回顾分析.选 择对EHCC切除术后预后可能产生影响的临床因素,通过Cox 比例风险模型进行多因素的预后分析.结果:在128例EHCC 中,59例施行了外科切除,69例施行了内或外引流术和非手 术治疗.在切除组59例中,根治性切除47例,姑息性切除12 例.其中,根治性切除1,3,5a生存率分别为72%,45%和 23%;姑息性切除1和3a生存率分别为54%和9%,无5a存 活者.根治性切除组和姑息性切除组生存率相比较,差异显 著(log ranktest,P<0.05).肿瘤的组织学类型、TNM分期、淋 巴结转移、胰腺浸润、切缘癌残留、手术切除方式对预后有重 要影响(P<0.05).结论:临床病理特征与预后有明显的相 关性,根治性切除可提高EHCC的远期生存率.AIM: To define the relationship between the clinicopathological features and the prognosis of extrahepatic cholangiocarcinoma (EHCC). METHODS: The clinicopathological features, surgical therapy and follow-up result were retrospectively analyzed in 128 cases of EHCC admitted into our hospital from January 1995 to December 2003. A multivariate analysis was performed in these patients by the Cox proportional hazard model. RESULTS: Of the 128 patients, 59 underwent surgical resection (radical resection in 47, palliative resection in 12) and 69 were subjected to nonresectional surgical treatment. The 1-, 3-, 5-year survival rates were 72%, 45% and 23% respectively in the radical resection group, while the 1-, 3-year survival rates were 54% and 9% respectively in palliative resection group and none survived for over 5 years. There were significant differences in the survival rate between the radical resection group and the palliative resection group (log-rank test, P<0.05). The multivariate analysis showed that the major significant prognostic factors influencing the survival of these patients were histological type of the lesion, TNM stages, lymph node metastasis, pancreatic invasion, residual tumor margins, and therapeutic interventions (P<0.05). CONCLUSION: A definite correlation exists between the prognosis and the clinicopathological features. Radical resection may help to improve the prognosis of EHCC.

关 键 词：胆管肿瘤 外科手术 病理学 预后 

分 类 号：R657.4[医药卫生—外科学]