肝门部胆管癌的手术治疗及预后的多因素分析：附41例  

Surgical treatment and prognostic analysis of hilar cholangiocarcinoma., a report of 41 cases

作　　者：徐威[1] 唐珍[1] 李永国[1] 

机构地区：[1]中南大学湘雅二医院普外科,长沙410000

出　　处：《中华肝胆外科杂志》2008年第9期621-624,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨肝门部胆管癌的手术治疗及生存预后的影响因素。方法回顾性分析中南大学湘雅二医院1999年1月至2007年2月手术治疗的41例肝门部胆管癌的临床特点，手术方式，及随访结果。COX比例风险模型进行预后的多因素分析。结果41例手术治疗中，切除手术21例，其中R0根治性切除11例，R1切除6例，R2切除4例，手术切除率51．2％（21／41），根治性切除率52．4％（11／21）。该组病例总体1、3、5年生存率分别为41．5％，14．6％，4．9％。切除术组1、3、5年生存率分别为71．3％，28．6％，9．5％。R0，R1，R2切除术后1、3、5年生存率分别为81．8％，45．5％，18．2％；66．7％，16．7％，0；50％，0，0。结论手术切除仍然是治疗HCC惟一有可能获得治愈和长期生存的有效手段。切缘无瘤，联合肝叶切除及肿瘤分期是影响预后的重要因素。Objective To explore surgical strategy for patients with hilar cholangiocarcinoma （HCC） and study prognostic factors after curative treatment. Methods We retrospectively reviewed medical records of 41 patients with HCC surgically treated in our department during the 9-year period from January 1999 to February 2007. Clinieopathological factors were evaluated for their association with post-operational survival by univariate and multivariate analysis using Cox proportional hazard model. Results All the 41 patients underwent laparotomy following preoperative assessment of extent of disease and 21 patients （resectability rate 51.2%） ultimately underwent resection with curative intent. In the resection group, R0 radical resection was possible in 11 patients, while R1 resection in 6 and R2 in 4. Different types of hepatectomy were combined to accomplish resection. Meanwhile, portal vein wedge resection or reconstruction was needed in two patients. The 1 , 3-and 5-year survival rates were 41.5%, 14.6% and 4.9% in the overall group and 71.3%, 28.6%, 9.5% in the resection group, respectively. In R0-resection, R1-resection and R2 resection group, the 1-, 3-and 5-year survival rates were 81.8%,45.5%,18.2%;66.7%,16.7%,0 and 50%,0,0, respectively. Survival rates after resection were significantly higher than those after palliative drainage and exploratory laparotomy （P〈0. 001）. Higher survival rates were seen in R0-resected patients when compared with R1-or R2- resected patients （P〈0. 001）. Multivariate analysis revealed that tumor-free margins, pTNM stage and combined hepatectomy were independent prognostic factors affecting survival. Conclusion Only surgery can provide chance to achieve the possibility of cure and long-term survival. Tumor-free margins, pTNM stage and combined hepatectomy are the most important prognostic factors affecting the survival.

关 键 词：胆管肿瘤 手术 预后 

分 类 号：R686[医药卫生—骨科学]