肝门部胆管癌的病理生物学特点及其临床意义的研究  

Biopathological characteristics of hilar cholangiocarcinoma and the clinical significance

作　　者：俞文隆[1] 张永杰[1] 董辉[1] 俞花[1] 冼志红[1] 吴孟超[1] 丛文铭[1] 

机构地区：[1]第二军医大学附属东方肝胆外科医院,上海200438

出　　处：《中华外科杂志》2009年第15期1162-1166,共5页Chinese Journal of Surgery

摘　　要：目的探讨肝门部胆管癌的病理生物学行为特点及其影响肝门部胆管癌患者手术切除后长期生存的外科病理学因素。方法对1998年4月至2008年4月经手术治疗且临床病理和随访资料完整的205例肝门部胆管癌患者的临床资料进行多参数系统性分析，对性别、年龄、术前血清CA19-9、术前肝功能Child分级、TNM分期、手术方式、胆管切缘、血管侵犯、肝脏侵犯、分化程度、胆管浸润深度、淋巴结转移和神经侵犯等13个临床病理学参数与总体生存时间的关系进行单因素分析，并通过Cox比例风险模型进行多因素分析。结果根治性切除占87．8％（n=180），组织学上硬化型腺癌占94．6％（n=194）。单因素分析显示，除性别、年龄、术前血清CA19-9和组织学类型等四项参数外，肝功能分级、TNM分期、手术方式、胆管切缘阳性、血管侵犯、癌周肝组织侵犯、肿瘤细胞分化程度、胆管浸润深度、淋巴结转移和神经侵犯等参数能明显影响肝门部胆管癌患者的预后（P〈0．05）。Cox风险比例模型多因素分析结果显示，淋巴结转移和胆管浸润深度是影响肝门部胆管癌患者切除后长期生存的2个独立的危险因素。结论淋巴结转移和胆管浸润深度是影响肝门部胆管癌患者手术预后的独立危险因素。以术中冰冻切片评估淋巴结转移和肿瘤对胆管壁及其周围组织的侵犯程度，可作为手术切除范围的组织学依据。Objective To approach the biopathological features of hilar cholangiocarcinoma and surgicopathological factors which influence the long-term survivals of patients with hilar cholangiocarcinoma. Methods A systemic and retrospective multi-parameter analysis was performed on 205 patients of hilar cholangiocarcinoma who received surgical treatments and had complete clinicopathological data as well as follow-up results during a ten-year-period from April 1998 to April 2008. The single factor analysis was performed on age, sex, content of pre-operative serum CA19-9, Child-pugh grading, TNM classification, operation pattern, resection margin status of bile duct, vascular invasion, adjacent liver involvement, grade differentiation, infiltration-depth of bile duct, lymph node metastasis and perineural infiltration. A multivariate analysis was performed through Cox proportional hazard model. Results The single factor analysis showed that except age, sex and content of pre-operative serum CA19-9, the mainly significant factors influencing the survivals were Child-Pugh grading, TNM classification, operation pattern, bile duct margin, vascular invasion, adjacent liver involvement, grade differentiation, infihrating-depth of bile duct, lymph node metastasis and perineural infiltration （P 〈 0. 05 ）. Lymph node metastasis and infiltration-depth of bile duct wall were found to be the two independent factors influencing overall survival by multivariate analysis through the Cox model. Conclusions The most important prognostic factors influencing the long-term survivals of patients with hilar cholangiocarcinoma after operation are lymph node metastasis and depth of tumor-infiltrating of involved bile duct. During the operation, standardized evaluation through frozen section should be carried out for detection of lymph node metastasis and depth of tumor-infiltrating of involved bile ducts, which can be used as the histological indicator for surgical expansion, and could be helpful to maximize avoiding the tumor cell residues an

关 键 词：胆管肿瘤 外科手术 病理学 临床 生物学行为 预后 

分 类 号：R686[医药卫生—骨科学]