不同治疗方法对肝门部胆管癌预后的影响  

EFFECT OF DIFFERENT TREATMENT METHODS ON THE PROGNOSIS OF HILAR CHOLANGIOCARCINOMA

作　　者：孙嵩 曹广华 仲灏辰 冯玉杰[1] 孙兆伟 张炳远[1] SUN Song;CAO Guanghua;ZHONG Haochen;FENG Yujie;SUN Zhaowei;ZHANG Bingyuan(Department of Hepatobiliary and Pancreatic Surgery,The Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院肝胆胰外科,山东青岛266003

出　　处：《青岛大学学报（医学版）》2021年第4期481-486,共6页Journal of Qingdao University(Medical Sciences)

基　　金：山东省自然科学基金资助项目(ZR2016HQ15)。

摘　　要：目的探讨不同的治疗方法对肝门部胆管癌(HCCA)病人预后的影响。方法回顾性分析我院2006—2015年收治的366例HCCA病人的临床资料,并根据治疗方法将病人分为根治性切除组、非根治性切除组和单纯减黄组。使用Kaplan-Meier生存曲线进行生存分析,并使用Cox比例风险模型评估HCCA的独立预后因素。结果根治性切除组(115例)、非根治性切除组(97例)以及单纯减黄组(154例)病人的1年生存率分别为71.7%、52.5%和35.3%,2年生存率分别为52.2%、25.8%和7.8%,3年生存率分别为36.7%、8.9%和0;中位生存期分别为23.6、14.7和9.7个月。3组病人的1、2、3年生存率及中位生存期比较差异均有统计学意义(χ^(2)=34.31~64.55,P<0.001)。多因素分析显示,治疗方法、清蛋白、总胆红素、术后病理T分期和远处转移等为HCCA的独立预后指标。结论根治性切除可显著提高HCCA病人的生存率,提高清蛋白水平和降低总胆红素水平可以改善HCCA病人的预后。Objective To investigate the effect of different treatment methods on the prognosis of patients with hilar cholangiocarcinoma(HCCA).Methods A retrospective analysis was performed for the clinical data of 366 patients with HCCA who were admitted to our hospital from 2006 to 2015,and according to treatment method,the patients were divided into radical resection group,non-radical resection group,and biliary drainage group.The Kaplan-Meier method was used for survival analysis,and the Cox proportional hazards model was used to identify independent prognostic factors for HCCA.Results There were 115 patients in the radical resection group,97 patients in the non-radical resection group,and 154 patients in the biliary drainage group.The three groups had 1-year survival rates of 71.7%,52.5%,and 35.3%,respectively,2-year survival rates of 52.2%,25.8%,and 7.8%,respectively,and 3-year survival rates of 36.7%,8.9%,and 0,respectively,and the median survival times in the three groups were 23.6,14.7,and 9.7 months,respectively.There were significant differences in 1-,2-,and 3-year survival rates and median survival time between the three groups(χ^(2)=34.31-64.55,P<0.001).The multivariate analysis showed that treatment method,albumin,total bilirubin,T stage based on postoperative pathology,and distant metastasis were independent prognostic factors for HCCA.Conclusion Radical resection can significantly improve the survival rate of HCCA patients,and increasing albumin level and reducing total bilirubin can improve the prognosis of HCCA patients.

关 键 词：Klatskin肿瘤 外科手术 预后 影响因素分析 

分 类 号：R735.7[医药卫生—肿瘤] R657.43[医药卫生—临床医学]