肝门部胆管癌预后因素分析  

Multivariate analysis of prognostic factors of hilar cholangiocarcinoma

作　　者：王越[1] 葛春林[1] 张军[1] 葛金年[1] 高君[1] 罗蓟[1] 

机构地区：[1]中国医科大学附属第一医院普通外科教研室肝胆外科,沈阳110001

出　　处：《中华消化外科杂志》2010年第3期183-185,共3页Chinese Journal of Digestive Surgery

基　　金：沈阳市卫生局科研课题（201066）

摘　　要：目的探讨影响肝门部胆管癌的预后因素。方法回顾性分析1996年1月至2007年5月中国医科大学附属第一医院收治的204例肝门部胆管癌患者的临床资料。生存时间用中位数表示，生存分析采用Kaplan—Meier法，行Log—rank检验，对17个可能影响预后的因素进行单因素分析，有统计学意义的单因素再采用Cox回归模型进行多因素分析。结果根治性切除中位生存时间为37个月，姑息性切除为18个月，胆道探查置管引流为11个月，剖腹探查为5个月，肝移植为25个月，五者比较差异有统计学意义（x^2=58．300，P〈0．05）。肿瘤最长径、门静脉或肝动脉侵犯、局部浸润、残端情况、肿瘤分化程度、淋巴结转移、手术方式对预后有影响（x^2=6．541，8．159，5．837，4．365，13．748，5．346，9．472，P〈0．05）。Cox回归模型多因素分析表明手术方式、肿瘤细胞分化程度是影响预后的独立因素（b=0．287，0．320，P〈0．05）。结论根治性切除是肝门部胆管癌最重要的预后因素，合理的围手术期处理能提高患者的生存率。Objective To investigate the prognostic factors of hilar eholangiocareinoma. Methods The clinical data of 204 patients with hilar cholangiocareinoma who were admitted to The First Affiliated Hospital of China Medical University from January 1996 to May 2007 were retrospectively analyzed. The survival rate was calculated using the Kaplan-Meier method and Log-rank test. Seventeen factors that may have influenced prognosis were analyzed by univariate analysis. Factors that were statistically significant were further analyzed by the Cox regression model. Results The median survival times of patients who received radical resection, palliative resection, bile duct exploration and catheter drainage, exploratory laparotomy, and liver transplantation were 37, 18, 11, 5 and 25 months, respectively, and there was a significant difference between the 5 groups （x^2 = 58. 300, P 〈0.05）. The prognostic factors included tumor size, portal vein or hepatic artery invasion, local invasion, resection margin, tumor grading, lymph node metastasis and surgical procedure （x^2 = 6. 541, 8. 159, 5. 837, 4. 365, 13. 748, 5. 346, 9. 472, P 〈0.05）. Multivariate analysis demonstrated that surgical procedure and tumor grading were independent prognostic factors （b = 0. 287, 0. 320, P 〈 0.05）. Conclusions Radical resection is the most important prognostic factor of hilar cholangiocarcinoma. Appropriate perioperative care can improve the survival rate.

关 键 词：胆管肿瘤 肝门 生存分析 预后因素 

分 类 号：R735.8[医药卫生—肿瘤]