不同术式治疗肝门部胆管癌的预后因素分析  

Factor Analysis of the Prognosis of Hilar Cholangiocarcinoma after Operation

作　　者：朱智辉[1] 白剑[2] 候小龙[1] 彭靖[1] 兰辉[1] 严跃红[2] 

机构地区：[1]怀化医学高等专科学校附属医院暨怀化市三医院普外科,湖南怀化418000 [2]广州医学院附属港湾医院普外科,广东广州510700

出　　处：《医学临床研究》2010年第1期82-84,共3页Journal of Clinical Research

摘　　要：【目的】探讨肝门部胆管癌（HCC）的外科治疗特点及预后因素，以期进一步提高HCC外科疗效。【方法]56例病理诊断为HCC患者，其中采用联合肝叶根治性切除21例，肿瘤局部切除11例，单纯引流24例。【结果】不同手术方法术后累计生存率差异显著（P〈0．001）。根治切除组1、3年生存率显著高于姑息切除组和单纯引流组，手术切除组较非手术切除组存活时间显著提高（P〈0．001）。术前T分期和Bithmuth分型能指导手术切除率及术式选择。不同的T分期的手术切除率及切缘阴性率差异显著（P〈0．001）。分别对16个可能影响预后的因素进行单因素预后分析表明肿瘤大小、门静脉侵犯、局部浸润及转移、手术方法、UICC分期、改良T分期、淋巴结转移对预后有影响，统计学上有显著性差异（P〈0．05）。Cox模型多因素预后分析表明手术方法、UICC分期是两个独立预后因素。【结论】根治性切除是最重要预后因素，扩大手术范围能获得较好切缘无癌率，术前的T分期和Bismuth分型综合评估将有助于进一步在安全的范围内提高手术切除率及根治性切除率。[Objective]To explore the surgical treatment and prognostic factors of hilar cholangiocarcinoma （HCC） and to improve the surgical effect of HCC. [Methods]The clinical data of 56 cases with HCC in our hospital were analyzed retrospectively. In all patients, 21 patients underwent radical resection of combined he- patic lobes, and 11 patients underwent local excision of the tumor, and 24 patients underwent simple drainage. [Results]The overall survival was significant different in the groups with different operative methods（ P〈 0. 001）. The 1, 3-year survival rates were significantly higher in the radical resection group than those in palliative resection group and drainage group. The overall survival time was significant longer in the radical resec- tion group than that in the non resection group（ P 〈0. 001）. Preoperative T-staging and Bithmuth typing could direct the operative selection. There was significant difference in the resection rate and negative rate of incisal margin with different T stages（ P 〈0. 001）. The results of univariate analysis of 16 possible factors af fecting the prognosis showed that tumor size, portal vein invasion, local infiltration and metastasis, surgical approaches, UICC staging, modified T-staging and lymphatic metastasis had the effect on the prognosis, and the difference had statistical significance（ P〈0.05）. Multivariate analysis by Cox proportional hazard model showed that surgical approaches and UICC staging were the two independent prognostic factors. [Conclusion] Radical resection is the most important prognostic factor of HCC. Enlarging the extent of surgery may achieve the better cancer-free rate of the incisal margin. T staging and Bismuth typing are helpful for improving the resection rate and radical resection rate.

关 键 词：胆管肿瘤/外科学 预后 

分 类 号：R735.8[医药卫生—肿瘤]