手术方式与肝门部胆管癌预后的关系分析  

Analysis of the relation between surgery and prognosis of hilar cholangiocarcinoma

作　　者：易滨[1] 张柏和[1] 张永杰[1] 姜小清[1] 张宝华[1] 俞文隆[1] 程庆保[1] 吴孟超[1] 

机构地区：[1]第二军医大学东方肝胆外科医院胆道外科,上海200438

出　　处：《中华外科杂志》2005年第13期842-845,共4页Chinese Journal of Surgery

摘　　要：目的研究影响肝门部胆管癌预后的因素,探讨手术方式与肝门部胆管癌预后的关系。方法对1997年12月至2002年12月收治的198例肝门部胆管癌资料进行回顾性队列研究。男性117例,女性81例。年龄27～81岁,平均56岁。黄疸(94.5%)、瘙痒(56.6%)和腹痛(33.8%)为主要症状。BismuthCorlette分型:Ⅰ型14例,Ⅱ型19例,Ⅲa型12例,Ⅲb型15例,Ⅳ型112例,分型不清楚者26例。手术治疗144例,120例(83.3%)获得切除,其中根治性切除59例(41.0%)。胆道探查置管引流24例。单纯内镜逆行内置管胆道引流(ERBD)或经内镜放置可膨式金属胆道支架(EMBE)21例,内镜鼻胆管引流(ENBD)31例,经皮经肝胆道引流2例。结果Cox模型分析结果显示术后生存时间与职业、术前最高血清总胆红素水平、手术方式和术后放疗四个因素显著相关,与以下因素关系不显著:性别、年龄、是否合并胆石、是否合并肝炎、术前CA199水平、BismuthCorlette分型、肿瘤分化程度和是否术后化疗。胆道置管引流、肿瘤姑息性切除、根治性切除组的术后生存期之间,两两比较均存在统计学差异。ERBD或EMBE组与姑息性切除组或与开腹胆道置管引流组之间,以及ENBD组与开腹胆道置管引流组间差异无统计学意义,ERBD或EMBE组与ENBD组间差异有统计学意义。结论手术方式是肝门胆管癌最重要的预后因素,根治性切除仍然是患者获得治愈和长期生存最重要的措施。对于无法根治切除的肝门胆管癌,尚不能认为ERBD或EMBE比开腹手术治疗的疗效差。Objective To explore the prognosis factors of hilar cholangiocarcinoma, and investigate the relation between operative procedure and prognosis of it. Methods A retrospective cohort study was investigated in 198 patients with hilar cholangiocarcinoma, who were treated in our hospital from December 1997 to December 2002. There were 117 males and 81 females. The age ranged from 27 to 81 years old with a mean of 56. Jaundice(94.5%), pruritus(56.6%) and abdominal pain(33.8%) were the main present symptoms. According to Bismuth-Corlette classification, there were 14 type I cases, 19 type II cases, 12 type IIIa cases, 15 type IIIb cases, 112 type IV cases and 26 unclassifiable cases. One hundred and forty four cases received open operative treatment, and the others only were treated with endoscopic approach(including ERBD or EMBE 21 cases, ENBD 31 cases) or percutaneous transhepatic cholangiodrainage(2 cases). Tumor resection was performed on 120 cases with a resection rate of 83.3%, included radical resection 59 cases(41.0%). Twenty-four cases underwent paunched biliary exploration and drainage. Results The Cox's regression model analysis showed that occupation, preoperative maximum total serum bilirubin level, operative procedure and postoperative adjuvant radiation affected postoperative survival significantly, but gender, age, choledocholithiasis, hepatitis, preoperative serum CA19-9 level, Bismuth-Corlette type, histopathologic grading and postoperative chemotherapy were not significant prognostic factors. The postoperative survival of biliary drainage group, palliative resection group and radical resection group, which statistically differed pairwise. Between ERBD or EMBE group and palliative resection group, there was no statistical difference. So was between ERBD or EMBE group and biliary drainage group, or between ENBD group and biliary drainage group. The survival differed statistically between ERBD or EMBE group and ENBD group. Conclusions Operative procedure was the most important prognosic factor of hilar c

关 键 词：肝门部胆管癌 手术方式 关系分析 可膨式金属胆道支架 胆道置管引流 2002年12月 根治性切除 回顾性队列研究 内镜鼻胆管引流 姑息性切除 肝门胆管癌 CA19-9 肿瘤分化程度 EMBE ERBD 手术治疗 胆道引流 ENBD 1997年 Cox模型 

分 类 号：R735.8[医药卫生—肿瘤] R123.1[医药卫生—临床医学]