肝门部胆管癌10年外科治疗经验  

Ten-year experience in surgical treatment of hilar cholangiocarcinoma

作　　者：姜小清[1] 易滨[1] 罗祥基[1] 刘辰[1] 谭蔚锋[1] 程庆保[1] 张柏和[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一科,上海200438

出　　处：《中华消化外科杂志》2010年第3期180-182,共3页Chinese Journal of Digestive Surgery

基　　金：上海市卫生局科研项目（2007Y29）;国家民政部课题[民人教科字（2008）47-2-39]

摘　　要：目的总结肝门部胆管癌单个治疗组10年外科治疗的经验。方法回顾性分析2000年1月至2009年12月第二军医大学东方肝胆外科医院收治的1572例肝门部胆管癌患者中，单个治疗组收治的462例患者的临床资料。其中手术治疗314例，非手术治疗148例。对可能影响预后的因素采用Kaplan—Meier生存分析、Log—rank检验以及Cox回归模型分析，不同因素间相关性分析采用x^2检验。结果314例行手术治疗的患者中，237例切除肿瘤，其中Rn切除174例、R，切除17例、R2切除46例。91例患者出现各种术后并发症，10例患者术后院内死亡。260例患者获得随访，总体1、3、5年生存率分别为71．7％、32．6％和10．9％；R0切除患者1、3、5年生存率分别为76．9％、48．6％和32．7％，中位生存时间为35个月。R。切除、TNM分期、区域淋巴结转移、肿瘤分化程度是预后的独立影响因素（RR=2．1，1．9，2．2，1．7，P〈0．05）。结论根治性切除仍然是肝门部胆管癌治愈的首选方法，术前系统性评估和准备可以提高根治切除率并减少手术并发症。Objective To summarize the experiences of a single treatment group in surgical treatment of hilar cholangiocarcinoma during the past 10 years. Methods From January 2000 to December 2009, 1572 patients with hilar cholangiocarcinoma were admitted to the Eastern Hepatobiliary Surgery Hospital, and the clinical data of 462 patients in our treatment group were retrospectively analyzed. Among the patients, 314 received surgical treatment, and the remaining 148 received conservative interventions or refused any therapy. Factors that may have influenced the prognosis were analyzed by the Kaplan-Meier method, Log-rank test and Cox proportional hazards model. The correlation of different factors was analyzed by the chi-square test. Results A total of 314 patients underwent surgical treatment and tumor resection was performed in 237 patients, including 174 with R0 resection, 17 with R1 resection, and 46 with R2 resection. There were 91 patients with postoperative complications and 10 in-hospital deaths. A total of 260 patients had been followed up for 5-113 months, and the overall 1-, 3-, and 5-year survival rates were 71.7% , 32.6% and 10.9% , respectively; the 1-, 3-, and 5-year survival rates of patients with R0 resection were 76.9% , 48.6% and 32.7% , respectively, with a median survival time of 35 months. R0 resection, TNM staging, regional lymph node involvement and tumor differentiation were the independent prognostic factors （RR = 2. 1, 1.9, 2. 2, 1.7, P 〈 0.05）. Conclusions Curative resection is the treatment of choice for hilar cholangiocareinoma. Preoperative systematic evaluation and preparation can improve the radical resection rate and reduce postoperative morbidity.

关 键 词：胆管肿瘤 肝门 外科手术 治疗 预后 

分 类 号：R735.8[医药卫生—肿瘤]