肝内胆管结石合并肝内胆管癌的临床病理特点及预后分析  

Clinicopathological characteristics and prognostic factors of hepatolithiasis associated with intrahepatic cholangiocarcinoma

作　　者：张春[1] 李涛[1] 董兆如[1] 罗黎希[1] 王钢普[1] 姜志超[1] 王祥宇[1] 智绪亭[1] 

机构地区：[1]山东大学齐鲁医院普外科,济南250012

出　　处：《中华肝胆外科杂志》2012年第12期893-897,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：国家自然科学基金（30972889）;山东大学自主创新基金（2010TS030）

摘　　要：目的探讨肝内胆管结石合并肝内胆管癌（hepatolithiasis associated with intrahepatic cholangiocarcinoma，HLAIHCC）的临床病理特点及预后影响因素。方法对2006年6月至2009年9月经手术治疗及病理证实的36例肝内胆管结石合并肝内胆管癌患者的临床病理特点和生存资料进行回顾性分析。结果HLAIHCC患者的1、3、5年总生存率分别为63．6％、36．4％与30．3％，与肝内胆管癌（intrahepatic cholangiocarcinoma，ICC）相比差异无统计学意义（65．4％、34．3％与28．6％，P=0．57）。接受根治性切除术患者1、3、5年生存率分别为81．4％、61．7％与58．6％，显著优于接受姑息性手术的患者（Х^2=20．426，P=0．000）。HLAIHCC外周血白细胞计数显著高于ICC（Х^2=19．700，P=0．000），肿瘤直径显著大于ICC（P=0．04）；血清CA19—9水平（P=0．049）和手术切缘（P=0．019）是影响预后的独立因素。结论HLAIHCC具有与ICC不同的临床病理特点，根治性切除术是最有效的外科治疗方法，血清CA19—9和手术切缘是影响预后的独立因素。Objective To investigate the clinicopathological characteristics and prognostic factors of hepatolithiasis associated with intrahepatic cholangiocarcinoma （HLAIHCC）. Method A retrospective study was conducted on 36 patients who suffered from histopathologically confirmed HLAIHCC. These patients received surgical resection of the tumor from June 2006 to September 2009. Results The overall 1-, 3 , 5-year survival rates for patients with HLAIHCC were not significantly better than those patients with ICC （63.6%, 36.40%, and 30.3i% vs. 65.4%,34.3%, and 28.6%,P=0.57）. For the patients who received curative resection, the 1-,3-, and 5-year survival rates （81.4 %, 61.7 %, and 58.6 %） were significantly better than those who received palliative resections （Х^2 = 20. 426, P〈0. 001）. The white blood cell count was significantly higher in the HLAIHCC group than in the ICC group （Х^2 =19.70, P〈0. 001） and tumor size was significantly smaller in the ICC group than in the HLAIHCC group （P=0.04）. Serum CA19-9 level （P=0. 049） and resection margin （P = 0. 019） were independent risk factors of prognosis. Conclusions This study showed HLAIHCC to have different clinicopathological characteristics from ICC. Curative resection was the optimal surgical treatment for HLAIHCC. Serum CA19 9 level and resection margin were independent risk factors of prognosis.

关 键 词：胆管肿瘤 胆结石 危险因素 

分 类 号：R735.8[医药卫生—肿瘤]