联合血管切除及重建在进展期肝门部胆管癌切除中的危险因素及生存分析  

Risk factors and survival analysis of combined vascular resection and reestablishment in progressive stage of hilar cholangiocarcinoma excision

作　　者：王鹤令[1] 周品一[1] 刘鹏[1] 张宇[1] 

机构地区：[1]中国医科大学附属盛京医院普通外科,辽宁沈阳110022

出　　处：《中国现代普通外科进展》2014年第9期700-703,共4页Chinese Journal of Current Advances in General Surgery

摘　　要：目的:研究联合血管切除(VR)及重建(RM)在进展期肝门部胆管癌(HC)切除中的应用情况。方法:收集2007年1月—2013年1月确诊为HC的50例患者,经HC根治术联合VR及RM方案治疗,将其作为观察组,另选55例同期肝部体检的健康人作为对照组。对HC实施单因素及多因素分析,并研究不同病理分期HC患者生存情况。结果:观察组在胆总管结石、肝胆管结石、胆囊结石、胆囊切除、胆道蛔虫病、肝吸虫病、肝血吸虫病等方面所占比例均显著高于对照组,差异均有统计学意义(均P<0.05) 。根据Logistic回归性分析,共有6个因素为危险因素,主要为胆总管结石、肝胆管结石、胆囊结石、胆囊切除、胆道蛔虫病和肝血吸虫疾病等。随访5年,失访1例,剩余49例均获随访。Ⅳ型HC患者1年存活率为88.9%(8/9);3年存活率为55.6%(5/9);5年存活率为33.3%(3/9)。Ⅲ型HC患者1年存活率为97.6%(40/41);3年存活率为82.9%(34/41);5年存活率为70.7%(29/41)。结论:HC根治术联合VR及RM方案治疗进展期HC,可明显提升患者的生存率,延长生存时间,疗效显著,值得临床推荐。Objective： To study application situation of combined vascular resection（VR） and reestablishment（RM） in progressive stage of hilar cholangiocarcinoma excisionin progressive stage of hilar cholangiocarcinoma excision. Method： From January 2007 to January 2013, there had atotal of 50 cases of hospital patients were diagnosed as HC, which was given HC radical surgery com- bined VR and RM regimen. It was grouped in the observation group, another chose 55 cases of patients with liver health test over the same period as the control group. The HC disease was done univariate and multivariate analysis, and compared survival of different stage of HC patient. Results： The ob- servation group＇s rate of bile duct stones, gallstones, cholecystectomy, biliary ascatiasis, liver fluke disease, schistosomiasis and other aspects of liver were significantly higher than the control group, the differences were statistically significant（P〈0.05）. With Logistic regression analysis based on a total of six factors as risk factors, mainly was： common bile duct stones, bile duct stones, gallstones, chole- cystectomy, bitiary ascariasis and dry schistosomiasis disease. After 5 years of follow-up, lost one case, the remaining 49 cases were followed up. IV type of HC patients＇ 1-year survival rate was 88.9%（8/9）, 3-year survival rate was 55.6%（5/9）, 5-year survival rate was 33.3%（3/9）. Ⅲ type of HC patients＇ 1 -year survival rate was 97.6%（40/41 ）, 3-year survival rate was 82.9%-34/41）, 5-year sur- vival rate was 70.7% （29/41）. Conclusion： HC radical mastectomy combined VR and RM in the treatment of advanced HC, can significantly improve the survival rate of patients and prolong survival time, which has a significant effect, it is worthy of recommendation.

关 键 词：血管切除与重建 肝门部胆管癌 危险因素 生存分析 

分 类 号：R615[医药卫生—外科学]