基于实际解剖部位命名的肝门部胆管癌分型方式的临床价值  

The clinical value of classification of hilar cholangiocarcinoma based on actual anatomy

作　　者：彭淑牖[1] 刘颖斌 李江涛[1] 吴向嵩[3] 金赟[1] 于源泉[1] 王许安 龚伟[3] Peng Shuyou;Liu Yingbin;Li Jiangtao;Wu Xiangsong;Jin Yun;Yu Yuanquan;Wang Xu′an;Gong Wei(Department of Hepato-Biliary-Pancreatic Surgery,the Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310006,China;Department of Biliary-Pancreatic Surgery,Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;Department of General Surgery,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China)

机构地区：[1]浙江大学医学院附属第二医院肝胆胰外科,杭州310006 [2]上海交通大学医学院附属仁济医院肝胆胰外科,上海200127 [3]上海交通大学医学院附属新华医院普外科,上海200092

出　　处：《中华外科杂志》2022年第9期860-865,共6页Chinese Journal of Surgery

基　　金：国家自然科学基金(81770614,81874181)。

摘　　要：目的评估以实际解剖部位命名的肝门部胆管癌分型方式对手术方式的指导意义及预后预测价值。方法回顾性收集2012年1月至2021年12月浙江大学医学院附属第二医院肝胆胰外科和上海交通大学医学院附属新华医院普外科收治的120例肝门部胆管癌患者的临床病理学资料及预后资料。男性57例,女性63例,年龄[M(IQR)]61(22)岁(范围:42~85岁)。根据实际解剖部位将肝门部胆管癌分为7型,患者均接受根治性切除,术中无肉眼可见肿瘤残留,且术中病理学检查结果显示胆管切缘阴性。分类变量的比较采用Pearsonχ^(2)检验或Fisher确切概率法检验,定量资料的比较采用单因素方差分析或Kruskal-Wallis秩和检验,生存分析采用Kaplan-Meier法,预后因素的分析采用Cox比例风险模型。结果120例患者中,33例术前根据以实际解剖部位命名的分型预设手术方式,并与实际手术方式比较,其中26例符合,7例不符合,符合率为78.8%。其余87例患者中,次叉型肝门胆管癌的联合门静脉切除比例、镜下切缘阳性比例和较高T分期比例更高,手术时间更长(P值均<0.05)。基于实际解剖部位的肿瘤分型的生存分析结果表明,单侧或主干组中位总体生存时间为27.0个月,双侧组为17.0个月,差异有统计学意义(HR=1.931,95%CI:1.066~3.499,P<0.05)。Cox比例风险模型多因素分析结果提示,根据实际解剖部位的肿瘤分型(HR=2.269,95%CI:1.333~3.861,P=0.003)、联合肝切除(HR=0.464,95%CI:0.253~0.848,P=0.013)及N分期(HR=6.317,95%CI:3.083~12.944,P<0.01)是肝门部胆管癌患者的独立预后因素。结论基于实际解剖部位命名的肝门部胆管癌分型相对简单、实用,对于肝脏切除方式、手术根治性及手术安全性具有一定的提示作用,同时有助于判断患者预后。Objective To examine the significance and prognostic value of the classification of hilar cholangiocarcinoma based on actual anatomical location.Methods A retrospective study was conducted including 120 patients of hilar cholangiocarcinoma treated at the Second Affiliated Hospital,Zhejiang University School of Medicine and Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2019 to December 2021.Patients with hilar cholangiocarcinoma were classified for seven types according to the site of tumor location.The clinicopathological and prognostic data of 120 patients were retrospectively analyzed(There were 57 males and 63 females,the age(M(IQR))was 61(22)years(range:42 to 85 years)).All patients received radical resection without visible intraoperative tumor residue and negative bile duct resection margin according to intraoperative pathological biopsy.The classification variables were analyzed by Pearsonχ^(2) test or Fisher′s exact probability test,one-way ANOVA or Kruskal-Wallis rank sum test.Kaplan-Meier method was used for survival analysis.Cox proportional risk model was used for prognostic factors.Results The coincidence rate of preoperative surgical planning and actual operational styles was verified in 33 cases.Twenty-six cases were consistent,and 7 cases were inconsistent,with a coincidence rate of 78.8%.According to the actual anatomical location,patients in type of secondary branch experienced a significantly longer operation duration,a higher portal vein resection rate,margin positive rate and more advanced T stage(all P<0.05).The median overall survival time of the unilateral main trunck group was 27.0 months,and the bilateral group was 17.0 months.Survival analysis based on the tumor classification of the actual anatomical location showed that the unilateral or main trunck group predicted less aggressive clinical features and favorable outcomes(HR=1.931,95%CI:1.066 to 3.499,P<0.05).Multivariate analysis demonstrated that the actual anatomical location of the t

关 键 词：胆管肿瘤 胆道外科手术 肝门部胆管癌 分型 解剖部位 治疗 

分 类 号：R735.8[医药卫生—肿瘤]