解剖性肝切除在肝内胆管癌治疗中的价值  

The role of anatomical hepatectomy in the treatment of intrahepatic cholangiocarcinoma

作　　者：吴向嵩[1] 陈燕[2] 靳云鹏[1] 李茂岚[1] 吴文广[1] 龚伟[1] 刘颖斌[1] 彭淑牖[2] Wu Xiangsong;Chen Yan;Jin Yunpeng;Li Maolan;Wu Wenguang;Gong Wei;Liu Yingbin;Peng Shuyou(Department of General Surgery, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Research Center of Biliary Tract Disease, Shanghai Key Laboratory of Biliary Tract Disease Research, Shanghai 200092, Chin)

机构地区：[1]上海交通大学医学院附属新华医院普外科,上海市胆道疾病研究中心,上海市胆道疾病研究重点实验室,200092 [2]浙江大学医学院附属第二医院普外科

出　　处：《中华外科杂志》2018年第4期269-273,共5页Chinese Journal of Surgery

基　　金：国家自然科学基金资助项目（81502433、31620103910、91440203）;上海市科委重点实验室项目（17DZ2260200）

摘　　要：目的探讨解剖性肝切除在肝内胆管癌治疗中的价值。方法回顾性分析上海交通大学医学院附属新华医院和浙江大学医学院附属第二医院2010年1月1日至2015年12月31日收治的98例行根治性切除的肝内胆管癌患者病例资料，其中男性55例（56.1%），女性43例（43.9%），中位年龄61岁。根据是否接受解剖性肝切除分为局部切除组（n＝30）和解剖性肝切除组（n＝68），比较两组患者之间手术相关因素。采用Kaplan－Meier方法绘制累积生存率曲线并进行Log－rank检验，采用Cox回归进行预后相关因素分析。结果解剖性肝切除组手术时间[（196.4±94.9）min]长于局部切除组[（166.2±65.7）min]（Z＝－2.217，P＝0.027），两组患者术中出血量、术中输血、术后并发症、术后死亡、术后住院天数的差异均无统计学意义（P值均〉0.05）。解剖性肝切除组中位生存时间为14个月，长于局部肝切除组的11个月（χ2＝4.641，P＝0.031）。总体生存时间的单因素分析结果显示，肿瘤分化程度、肿瘤数量、T分期、N分期、是否解剖性肝切除、术后辅助治疗患者的预后因素。进一步多因素分析结果提示，肿瘤数量（HR＝0.522，95%CI：0.259-0.974，P＝0.042）和解剖性肝切除（HR＝1.858，95% CI：1.092-3.161，P＝0.022）是影响肝内胆管癌患者独立预后因素。结论与局部肝切除相比，解剖性肝切除在不影响手术安全的同时，可改善肝内胆管癌患者的预后。Objective To evaluate the role of anatomical hepateetomy in the treatment of intrahepatic cholangiocareinoma. Methods The cases of intrahepatic cholangioearcinoma who received curative surgery in two hospitals from 2010 to 2015 were analyzed retrospectively. Among the 98 patients enrolled in this study, 55 were male and 43 were female. The median age was 61 years. According to receiving anatomical hepateetomy or not, the 98 cases were divided into two groups： non-anatomical hepatectomy（n= 30） and anatomical hepatectomy（n= 68）. The surgical results were compared between the two groups. Survival curves were plotted by the Kaplan-Meier method and compared by the log-rank test. The influence of each prognostic factor identified by univariate analysis was multivariate analysis by Cox＇s proportional hazard regression. Results The duration of surgery was significantly prolonged in the anatomical hepatectomy group（（196.4±94. 9）minutes vs. （ 166. 2±65.7）minutes,P= 0. 027）, while there was no significant difference in terms of other surgical results such as intraoperative blood transfusion, postoperative morbidity and mortality rate. Compared to non-anatomical hepatectomy, anatomical hepatectomy significantly improved long-term survival results （ 14 months vs. l 1 months） （X2= 4. 641,P = 0. 031 ）. Single variable analysis indicated that tumor differentiation, tumor numbers, T stage, N stage, anatomical hepatectomy and adjuvant therapy significantly affected overall survival. Multivariate analysis demonstrated that tumor numbers（HR = 0. 522, 95% CI： 0.259 - 0.974, P =- 0. 042） and anatomical hepatectomy （ HR = 1. 858, 95%CI： 1. 092-3. 161 ,P= 0. 022） were two independent prognostic factors for overall survival. Conclusion Compared to non-anatomical hepatectomy, anatomical hepatectomy performed for intrahepatic cholangiocarcinoma is not only safe but also beneficial for long-term survival.

关 键 词：肝肿瘤 肝切除术 肝内胆管癌 解剖性肝切除 

分 类 号：R735.7[医药卫生—肿瘤]