104例肿块型肝内胆管细胞癌病人的临床病理特征、诊断和外科治疗研究  

Clinicopathological features, diagnosis and surgical treatment of mass-forming type intrahepatic cholangiocarcinoma:a study of 104 cases

作　　者：傅晓辉[1] 宗明[1] 杨广顺[1] 姚晓平[1] 吴孟超[1] 

机构地区：[1]第二军医大学东方肝胆外科医院,上海市200438

出　　处：《中华肝胆外科杂志》2005年第12期797-801,共5页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的分析外科手术治疗后的肝内胆管细胞癌病人临床病理特征与生存时间的相关性。方法从1996年11月至2000年5月共有104例肝内胆管细胞癌病人接受手术治疗。对其临床资料进行归纳,并随访调查。成功回访79例(76·0%)。对16个临床病理因素(年龄、性别、慢性肝病史、HBsAg携带、手术方式、辅助治疗、腹水、淋巴结转移、邻近器官侵犯、肿瘤大小、肿瘤坏死、肿瘤包膜、肝内转移、TNM分期、组织学分级、肝硬化)进行了单因素和多因素相关分析,以了解它们对治疗预后的影响。结果79例病人的1,3,5年生存率分别为49·4%,17·3%和9·6%。单因素相关分析显示性别(P=0·0221),HBsAg携带(P=0·0115),手术方式(P=0·0042),辅助治疗(P=0·0389),腹水(P=0·0001),临近器官侵犯(P=0·0220),肝内转移(P=0·0000),TNM分期(P=0·0001)与生存时间相关。多因素分析表明HBsAg携带、腹水和TNM分期与预后显著相关。结论早期诊断和早期治疗以及规则性肝切除是改善肝内胆管细胞癌外科治疗效果的关键因素。Objective To analyze the relationship between clinicopathological features and the survival time after operation in patients with mass-forming type intrahepatic cholangiocarcinoma （ICC）. Methods The operation was performed for 104 patients with mass-forming type ICC in our hospital from November 1996 to May 2000. Seventy-nine of them （76.0 %） were followed up successfully. Sixteen clinicopathological variables including age, sex, history of chronic liver disease, HgsAg, operation, adjuvant therapy, ascites, lymph node metastasis, invasion of adjacent organs, tumor size, necrosis of tumor, envelope, intrahepatic metastasis, UICC TNM staging, histology and cirrhosis were selected for univariate and multivariate analyses to investigate their influence on the prognosis. Results The accumulative 1-, 3 and 5-year survival rates of the 79 patients were 49.4%, 17.3 % and 9.6%, respectively. The univariate analysis revealed that sex （P = 0. 0221）, HBsAg （P = 0. 0115）, operation （P=0. 0042）, adjuvant therapy （P=0. 0389）, ascites （P=0. 0001）, invasion （P = 0. 0220）, intrahepatic metastasis （P = 0. 0000） and TNM stage （P= 0. 0001 ） were correlated to the survival time. Multivariate analysis showed that HBsAg, ascites and TNM stage were significantly relative factors for prognosis. Conclusions Early diagnosis and treatment and major hepatectomy are key points for improving the results of the surgical therapy for patients with ICC.

关 键 词：胆管肿瘤 外科学 病理学 

分 类 号：R735.8[医药卫生—肿瘤]