Bismuth-Corlette III、IV型肝门部胆管癌手术治疗方式的选择  

Selection of surgical treatment for Bismuth-Corlette type III and IV hilar cholangiocarcinoma

作　　者：卢灿亮[1] 张超[1] 许业传[1] 钱叶本[1] Lu Canliang;Zhang Chao;Xu Yechuan;Qian Yeben(Department of General Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院普外科,合肥230022

出　　处：《中华肝胆外科杂志》2022年第8期597-602,共6页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的分析不同手术方式治疗Bismuth-Corlette III、IV型肝门部胆管癌(HCCA)的疗效及预后,探讨其合理的治疗方式。方法回顾性分析2010年1月至2016年12月安徽医科大学第一附属医院手术治疗的86例Bismuth-Corlette III、IV型HCCA患者的临床资料,其中男性45例,女性41例,年龄(59.5±10.5)岁。按照手术方式不同分为扩大肝切除组(57例)和围肝门切除组(29例),比较两组患者的围手术期指标和生存率。通过住院复查、定期门诊复查或电话随访。单因素及多因素Cox回归分析影响预后的因素。结果扩大肝切除组的手术时间和术中失血量均大于围肝门切除组[320(270,380)min比270(210,300)min,P<0.001;300(200,400)ml比100(100,150)ml,P<0.001]。扩大肝切除组Clavien-Dindo III级及以上并发症发生率和国际肝脏外科研究组C级肝功能衰竭发生率均高于围肝门切除组[36.4%(20/57)比13.8%(4/29),P=0.037;13.8%(7/57)比0(0/29),P=0.047],差异均具有统计学意义。扩大肝切除组手术后1、3、5年累积生存率分别为89.5%、38.6%、19.3%,围肝门切除组分别为86.2%、20.7%、10.3%,两组比较生存差异具有统计学意义(P=0.048)。多因素分析显示围肝门切除(HR=1.958,95%CI:1.174~3.268,P=0.010)、非R0切除(HR=6.040,95%CI:2.915~12.513,P<0.001)、TNM分期III/IV期(HR=2.144,95%CI:1.257~3.654,P=0.005)是影响HCCA患者手术后总体生存的独立危险因素。结论Bismuth-Corlette III、IV型HCCA行扩大肝切除术后总体生存率高于行围肝门切除者,但其手术并发症和肝功能衰竭的发生率也增高。Objective To analyze the efficacy and prognosis of different surgical treatments for Bismuth-Corlette type III and IV hilar cholangiocarcinoma(HCCA).Methods The clinical data of 86 Bismuth-Corlette type III and IV HCCA patients treated at the First Affiliated Hospital of Anhui Medical University from January 2010 to December 2016 were retrospectively analyzed.There were 45 males and 41 females with age of(59.5±10.5)years old.According to the operative method,57 patients were included into the extended hepatectomy group,and 29 patients into the perihilar hepatectomy group.The perioperative clinical data and survival rates were compared between the two groups.Through inpatient interviews,regular outpatient or telephone follow-up,factors affecting prognosis were analyzed by univariate and multifactorial Cox regression.Results The operative time and intraoperative blood loss in the extended hepatectomy group were significantly higher than those in the perihilar hepatectomy group,[320(270,380)min vs.270(210,300)min,P<0.001;300(200,400)ml vs.100(100,150)ml,respectively P<0.001].The incidences of≥Clavien-Dindo grade III complications and ISGLS grade C liver failure in the extended hepatectomy group were significantly higher than those in the perihilar hepatectomy group[36.4%(20/57)vs.13.8%(4/29),P=0.037;13.8%(7/57)vs.0(0/29),respectively P=0.047].The cumulative 1-,3-and 5-year survival rates of the extended hepatectomy group were 89.5%,38.6%and 19.3%,respectively.The cumulative 1-,3-and 5-year survival rates of perihilar hepatectomy group were 86.2%,20.7%and 10.3%,respectively.The difference between the two groups was statistically significant(P=0.048).Multivariate analysis showed that perihilar hepatectomy(HR=1.958,95%CI:1.174-3.268,P=0.010),non-R0 resection(HR=6.040,95%CI:2.915-12.513,P<0.001)and TNM stage III/IV(HR=2.144,95%CI:1.257-3.654,P=0.005)were independent risk factors for overall survival after surgery for HCCA patients(P<0.01).Conclusions Patients with Bismuth-Corlette type III and IV HCCA who received ex

关 键 词：Klatskin肿瘤 Bismuth-Corlette分型 扩大肝切除 围肝门切除 生存率 

分 类 号：R735.8[医药卫生—肿瘤]