淋巴结相关参数对远端胆管癌患者术后远期预后的影响  

Influence of lymph node-related parameters on postoperative long-term prognosis of patients with distal cholangiocarcinoma

作　　者：潘冰[1] 任章勇 赵昕[1] 李立新[1] 吕少诚[1] 贺强[1] Pan Bing;Ren Zhangyong;Zhao Xin;Li Lixin;Lyu Shaocheng;He Qiang(Department of Hepatobiliary Pancreatic and Spleen Surgery,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院肝胆胰脾外科,北京100020

出　　处：《国际外科学杂志》2022年第12期819-825,F0004,共8页International Journal of Surgery

摘　　要：目的分析远端胆管癌患者的淋巴结性质、淋巴结阳性数目、淋巴结阳性率与术后远期预后的相关性。方法采用回顾性队列研究的方法分析首都医科大学附属北京朝阳医院2015年1月—2021年12月收治的104例远端胆管癌患者的临床资料及随访结果。104例患者均接受胰十二指肠切除术。根据患者淋巴结性质、淋巴结阳性数目、淋巴结阳性率,确定SUVmax临界值,以临界值将患者分为低危组和高危组。淋巴结阳性组37例,阴性组67例;在淋巴结阳性组中,按淋巴结阳性数目(临界值为2),分为低危组(淋巴结阳性数目<2个,n=14),高危组(淋巴结阳性数目≥2个,n=23);按淋巴结阳性率分组(临界值为0.13),低危组(淋巴结阳性率<0.13,n=15),高危组(淋巴结阳性率≥0.13,n=22)。按照不同淋巴结参数分组后,分析患者术前一般资料如年龄、性别、实验室检查等,围手术期并发症以及远期预后的相关性。符合正态分布的计量资料采用均数±标准差(±s)表示,组间比较采用独立样本t检验;非正态分布的计量资料采用中位数M(Q_(1),Q_(3))表示,组间比较采用秩和检验。计数资料组间比较采用χ^(2)检验,总例数小于50,采用Fisher确切概率法。采用x-tile 3.6.1软件确定不同淋巴结参数的最佳临界值。应用Kaplan-Meier法计算并绘制生存曲线,生存率的比较采用Log-rank检验。结果 104例患者均顺利完成手术,围手术期死亡患者5例(4.8%)。淋巴结阳性患者与淋巴结阴性患者的术后中位生存时间分别为17个月和36个月,术后1、3、5年总体生存率分别为64.9%、23.9%、23.9%和81.5%、49.8%、41.7%(P=0.003)。在依据淋巴结阳性数目分组的患者中,低危组和高危组患者的术后中位生存时间分别为21个月和17个月,两组患者的术后1、3、5年总体生存率分别为77.1%、42.9%、42.9%和58.2%、13.8%、13.8%(P=0.284);在依据淋巴结阳性率分组的患者中,低危组和高危组�Objective To analyse the correlation between the lymph nodes,the number of positive lymph nodes,the positive rate of lymph nodes and the long-term prognosis of patients with distal cholangiocarcinoma.Methods The clinical data and follow-up results of 104 patients with distal cholangiocarcinoma admitted to Beijing Chaoyang Hospital Affiliated to Capital Medical University from January 2015 to December 2021 were retrospectively analyzed using a retrospective cohort study.All patients underwent pancreaticoduodenectomy.According to the nature of the patients′lymph nodes,the number of positive lymph nodes,and the positive rate of lymph nodes,the X-tile software was used to analyze data respectively,and the critical value of SUVmax were determined,and the patients were divided into low-risk group and high-risk group by critical values.Based on this critical value,the patients were divided into low-risk groups and high-risk groups.There were 37 patients in the lymph node positive group and 67 patients in the negative group.In the lymph node positive group,according to the number of positive lymph nodes(the cut-off value=2),they were divided into the low-risk group(n=14),the high-risk group(n=23);grouped according to the lymph node positive rate(the cut off=0.13),and divided into the low-risk group(n=15),and the high-risk group(n=22).After grouping according to different lymph node parameters,the preoperative general data such as age,gender,laboratory examination,etc.,the correlation between perioperative complications and long-term prognosis were analyzed.The measurement data conforming to the normal distribution was expressed as mean±standard deviation(±s),and the t test was used for comparison between groups;the measurement data that was not normally distributed was expressed as M(Q1,Q3),and the comparison between groups was performed by the rank sum test.The enumeration data were expressed by the number of cases,and the comparison between groups was performed using the chi-square test.If the total number of cases

关 键 词：淋巴结 胆管肿瘤 预后 胰十二指肠切除术 淋巴结阳性数目 淋巴结阳性率 

分 类 号：R735.8[医药卫生—肿瘤]