322例肝门部胆管癌的临床疗效及预后因素分析  

Clinical efficacy and prognostic factors analysis of hilar cholangiocarcinoma in 322 patients

作　　者：隋鑫磊 汤恢焕[1] 肖广发[1] 陆晔斌[1] 何群[1] 周军[1] 魏伟[1] 梁帅[1] 黄耿文[1] 孙维佳[1] 李宜雄[1] 龚学军[1] 

机构地区：[1]中南大学湘雅医院胆胰外科,长沙410008

出　　处：《中华消化外科杂志》2017年第4期391-397,共7页Chinese Journal of Digestive Surgery

基　　金：湖南省自然科学基金面上项目（13JJ5009）

摘　　要：目的探讨肝门部胆管癌的临床疗效及影响预后的因素。方法采用回顾性病例对照研究方法。收集2005年12月至2015年11月中南大学湘雅医院收治的322例肝门部胆管癌患者的临床病理资料。患者行实验室检查和影像学检查，根据检查结果进行术前肿瘤分期、分型并制订治疗方案。观察指标：（1）临床表现及辅助检查结果。（2）治疗及病理学检查结果。（3）随访和生存情况。（4）预后因素分析：性别、年龄、术前最高血清TBil、术前CEA、术前CA19—9、术前CA242、术前CA125、治疗方法、TNM分期。采用门诊及电话方式进行随访，以患者死亡为终点．了解患者生存情况。随访时间截至2016年11月。采用Kaplan—Meier法绘制生存曲线，Log—rank检验进行生存分析及单因素分析，COX比例风险回归模型进行多因素分析。结果（1）临床表现及辅助检查结果：322例患者中，301例以黄疸为主诉。322例患者术前最高血清TBil水平为3．9～785．2μmol／L，DSil为1．6～410．2μmol／L，ALT为14．8～484．5U／L，AST为21．4～539．8U／L；272例检测ALP、GGT，其水平分别为93．8-1890．0U／L、2．0～1832．8U／L；292例检测CEA，升高者77例：298例检测CA19—9，升高者272例；260例检测CA242、CA125，升高者分别为153、86例。322例患者根据Bismuth-Cor]ette分型：I型24例、Ⅱ型115例、Ⅲa型55例、Ⅲb型63例、Ⅳ型65例。（2）治疗及病理学检查结果：322例患者中，104例行根治性切除术，其中围肝门胆管切除术79例（联合血管切除重建术9例），扩大肝叶切除术25例（联合肝尾状叶切除术16例）；218例行姑息治疗，其中胆道外引流术134例，胆肠内引流术84例。围术期死亡5例，其中2例急性肝衰竭，1例全身感染、多器官衰竭，1例急性肾衰竭，1例急性化脓性胆管炎、感染性休克、全身弥散性血管内凝血。263例患者行病理学Objective To investigate clinical efficacy and prognostic factors of hilar cholangioearcinoma. Methods The retrospective ease-control study was conducted. The clinieopathological data of 322 patients with hilar eholangioearcinoma who were admitted to the Xiangya Hospital of Central South University between December 2005 and November 2015 were collected. Preoperative staging and classification of tumor and treatment planning were carried out according to the results of laboratory and imaging examinations. Observation indexes ： （ 1 ） clinical features and results of assisted examinations; （2） treatments and results of pathological examination; （3） follow- up and survival; （4） prognostic factors analysis： gender, age, preoperative highest total bilirubin （TBil）, preoperative careinoembryonie antigen （CEA） , preoperative CA19-9, preoperative CA242, preoperative CA125, treatment methods and TNM staging. The follow-up of outpatient examination and telephone interview was performed to detect patients＇ survival up to November 2016. Survival curve was drawn using the Kaplan-Meier method. Survival and univariate analyses were done using the Log-rank test, and multivariate analysis was done using the Cox proportional hazard model. Results （ 1 ） Clinical features and results of assisted examinations ： among the 322 patients, there were 301 patients with a chief complaint of jaundice. Of the 322 patients, the preoperative highest levels of TBil, DBil, ALT and AST in 322 patients were 3.9-785.2μmol/L, 1.6-410. 2 μmol/L, 14. 8-484. 5 U/L and 21.4-539. 8 U/L, respectively. Levels of ALP and GGT in 272 patients were 93.8-1 890. 0 U/L and 2.0- 1 832.8 U/L, respectively. Seventy-seven of 292 patients had an elevated CEA level, 272 of 298 patients had an elevated CA19-9 level, 153 of 260 patients had an elevated CA242 level and 86 of 260 patients had an elevated CA125 level. According to Bismuth-Corlette type, 24 patients were detected in type Ⅰ , 115 in type Ⅱ , 55 in type Ⅲ a, 63 in typ

关 键 词：胆道肿瘤 肝门部 疗效 预后因素 

分 类 号：R735.8[医药卫生—肿瘤]