十二指肠上段远端胆管癌与Bismuth-CorletteⅠ型肝门部胆管癌手术治疗的比较研究  

Comparative study of the surgical treatment for supraduodenal distal cholangiocarcinoma and Bismuth-Corlette type I hilar cholangiocarcinoma

作　　者：卢灿亮[1] 钱叶本[1] 张超[1] Lu Canliang;Qian Yeben;Zhang Chao(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：《中华普通外科杂志》2023年第2期123-127,共5页Chinese Journal of General Surgery

摘　　要：目的分析十二指肠上段远端胆管癌(supraduodenal distal cholangiocarcinoma,SDC)与Bismuth-CorletteⅠ型肝门部胆管癌(Bismuth-Corlette type I hilar cholangiocarcinoma,BIC)的手术疗效及预后,探讨不同部位胆管癌的临床特点。方法回顾性分析2009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33例SDC和25例BIC患者的临床资料。结果BIC组4例(16.0%)联合尾状叶切除,SDC组无尾状叶切除(P=0.030)。SDC组和BIC组胰漏发生率分别为18.2%(6/33)和0(0/25),差异有统计学意义(P=0.032)。SDC组手术后1、3、5年累积生存率分别为94.0%、54.5%、30.3%,BIC组分别为88.0%、28.0%、16.0%,两组间差异有统计学意义(P=0.045)。BIC、非R0切除、AJCC分期Ⅲ/Ⅳ期均是手术后总体生存的独立危险因素。结论SDC患者根治性手术切除后总体生存率显著高于BIC组。Objective To analyze the surgical efficacy and prognosis of supraduodenal distal cholangiocarcinoma(SDC)and Bismuth-Corlette type I hilar cholangiocarcinoma(BIC),and to explore the clinical characteristics of cholangiocarcinoma at different sites.Methods The clinical data of 33 patients with SDC and 25 patients with BIC undergoing surgical treatment at the First Affiliated Hospital of Anhui Medical University from Jan 2009 to Dec 2016 were analyzed retrospectively.Results In the BIC group,four patients(16.0%)had combined caudate lobectomy,while in SDC group no caudate lobectomy was needed(P=0.030).The incidence of pancreatic fistulae in SDC group and BIC group was 18.2%(6/33)and 0(0/25),respectively(P=0.032).The cumulative survival rates 1,3,and 5 years after operation were 94.0%,54.5%,and 30.3%in SDC group and 88.0%,28.0%,and 16.0%in BIC group,respectively(P=0.045).Univariate analysis showed that location of cholangiocarcinoma,residual status and AJCC stage were correlated with postoperative prognosis of cholangiocarcinoma patients.Multivariate analysis showed that BIC,non-R0 resection and AJCC stageⅢ/Ⅳwere independent risk factors for overall survival after surgery.Conclusion The overall survival rate of SDC patients after radical surgical resection was significantly higher than that of the BIC group.

关 键 词：胆管上皮癌 外科手术 并发症 生存率 

分 类 号：R735.8[医药卫生—肿瘤]