胰十二指肠切除术治疗远端胆管癌的预后多因素分析  

Multivariate analysis of prognosis after pancreaticoduodenectomy for distal bile duct cancer

作　　者：储云绵 车旭[1] 兰忠民[1] 陈应泰[1] 张建伟[1] 王成锋[1] 

机构地区：[1]北京协和医学院中国医学科学院肿瘤医院腹部外科,北京100021

出　　处：《中国医刊》2015年第5期42-45,共4页Chinese Journal of Medicine

基　　金：2008年度中国医学科学院肿瘤医院临床科研课题(LC2008B43)

摘　　要：目的分析远端胆管癌患者接受根治性切除术后预后影响因素。方法回顾性统计在本院接受胰十二指肠切除术的78例远端胆管癌病例。采用Kaplan-Meier法分析各项临床病理因素与远端胆管癌患者预后的相关性,Cox风险比例模型对预后影响因素进行多因素分析。结果所有病例的总体3年生存率为47.26%,5年生存率为23.99%。淋巴结转移比率为0、0~0.2、〉0.2~0.5、〉0.5的5年生存率分别为28.59%、21.60%、18.84%、10.03%。单因素分析结果表明肿瘤分化程度、淋巴结转移与否、淋巴结转移比率、TNM（tumor node metasics,TNM）分期和切缘情况与远端胆管癌患者的术后生存有相关性（P〈0.05）;多因素分析结果表明淋巴结转移比率和TNM分期是影响远端胆管癌切除术后预后的独立因素（P〈0.05）。结论 TNM分期淋巴结转移比率是远端胆管癌患者行根治性切除术后的一项独立的预后因素,对预测患者术后生存有重要意义。Objective To investigate the prognostic significance in patients undergoing radical resection for distal cholangiocarcinoma. Method A total of 78 patients who underwent pancreaticoduodenectomy for at the department of Abdominal Surgery, Cancer Institute ＆amp; Hospital, Chinese Academy of Medical Sciences were analyzed retrospec-tively. Potential clinicopathological prognostic factors were examined by univariate and multivariate survival analysis. Result The 3 and 5-year overall survival rates were 47. 26% and 23. 99%, respectively. The 3 and 5-year survival rates for patients with LNRs of 0, 0 to 0. 2, 0. 2 to 0. 5 and above 0. 5 were 28. 59%,21. 60%,18. 84%and 10. 03%, respectively. Univariate analysis revealed the tumor differentiation degree, lymph node status,ML-NR, TNM stage and positive margin were significant factors influencing postoperative survival （P〈0. 05）. The TNM stage and MLNR were independent predictors of poor prognosis by a Cox proportional hazards regression model （ P〈0. 05）. Conclusion The TNM stage and MLNR was an independent prognostic factor for patients after radical resec-tion and was of great importance in predicting patients survival.

关 键 词：远端胆管癌 根治性手术 预后 COX分析 

分 类 号：R575.7[医药卫生—消化系统]