基于多学科诊断与治疗的肝门部胆管癌外科手术疗效和预后影响因素分析  

Surgical efficacy and prognosis influencing factors of hilar cholangiocarcinoma based on multidisciplinary diagnosis and treatment

作　　者：毛谅[1] 杨翼飞 艾力西尔·艾拜都拉 周铁[1] 伏旭[1] 程浩[1] 张静[1] 梁有俊[1] 凡银银 孔文韬[2] 何健[3] 李爱梅[3] 唐敏[4] 周群[4] 贺奇彬 王轶[6] 王雷[6] 孔炜伟[7] 沈洁[7] 刘宝瑞[7] 陈骏[8] 史炯[8] 黎琪[8] 刘昭[9] 仇毓东[1] Mao Liang;Yang Yifei;Alexer Abaydulla;Zhou Tie;Fu Xu;Cheng Hao;Zhang Jing;Liang Youjun;Fan Yinyin;Kong Wentao;He Jian;Li Aimei;Tang Min;Zhou Qun;He Qibin;Wang Yi;Wang Lei;Kong Weiwei;Shen Jie;Liu Baorui;Chen Jun;Shi Jiong;Li Qi;Liu Zhao;Qiu Yudong(Department of Biliary-Pancreatic Surgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Department of Ultrasonography,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Department of Nuclear Medicine,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Department of Medical Imaging,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Department of Gastroenterology,the Affiliated Jiangning Hospital of Nanjing Medical University,Nanjing 210008,China;Department of Gastroenterology,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Department of Oncology,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Department of Pathology,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Department of Vascular Surgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院胆胰外科,南京210008 [2]南京大学医学院附属鼓楼医院超声诊断科,南京210008 [3]南京大学医学院附属鼓楼医院核医学科,南京210008 [4]南京大学医学院附属鼓楼医院医学影像科,南京210008 [5]南京医科大学附属江宁医院消化内科,南京210008 [6]南京大学医学院附属鼓楼医院消化科,南京210008 [7]南京大学医学院附属鼓楼医院肿瘤科,南京210008 [8]南京大学医学院附属鼓楼医院病理科,南京210008 [9]南京大学医学院附属鼓楼医院血管外科,南京210008

出　　处：《中华消化外科杂志》2023年第7期873-883,共11页Chinese Journal of Digestive Surgery

基　　金：国家重点研发计划(2020YFA0713803)。

摘　　要：目的探讨基于多学科诊断与治疗的肝门部胆管癌外科手术疗效和预后影响因素。方法采用回顾性队列研究方法。收集2004年4月至2021年4月南京大学医学院附属鼓楼医院收治的91例行手术切除肝门部胆管癌患者的临床病理资料;男59例,女32例;年龄为(61±10)岁。2004年4月至2014年3月收治的患者采用传统外科诊断与治疗模式,2014年4月至2021年4月收治的患者采用多学科诊断与治疗模式。观察指标:(1)手术情况。(2)术后情况。(3)术后病理学检查情况。(4)术后预后分析。(5)术后预后影响因素分析。采用电话和门诊方式进行随访,术后每6个月随访1次,了解患者术后生存情况。随访时间截至2023年4月。正态分布的计量资料以x±s表示,组间比较采用独立样本t检验;偏态分布的计量资料以M(范围)表示,组间比较采用Mann⁃Whitney U检验。等级资料比较采用秩和检验。计数资料以绝对数或百分比表示,组间比较采用χ^(2)检验或Fishe确切概率法。采用Kaplan⁃Meier法绘制生存曲线并计算生存率,Log⁃Rank检验进行生存分析。单因素和多因素分析采用COX比例风险模型。结果(1)手术情况。91例患者中,65例行半肝或扩大半肝切除术,13例行肝三区切除术,9例行部分肝切除术,4例仅行肝外胆管切除术;24例联合门静脉切除重建,8例联合胰十二指肠切除术,6例联合肝动脉切除重建;24例行扩大根治术(包括肝三区切除、肝动脉切除重建和肝胰十二指肠切除)。91例患者手术时间为(590±124)min,术中出血量为800(500~1200)mL,术中输血率为75.8%(69/91)。2004年4月至2014年3月收治的31例和2014年4月至2021年4月收治的60例患者扩大根治术、术中出血量分别为4例、650(300~1000)mL和20例、875(500~1375)mL,两者比较,差异均有统计学意义(χ^(2)=4.39,Z=0.31,P<0.05)。(2)术后情况。91例患者术后住院时间为(27±17)d,术后发生感染性并发症50例(腹腔�Objective To investigate the surgical efficacy and prognosis influencing factors of hilar cholangiocarcinoma based on multidisciplinary diagnosis and treatment.Methods The retrospective cohort study was conducted.The clinicopathological data of 91 patients with hilar cholangiocarcinoma who underwent surgery in Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School from April 2004 to April 2021 were collected.There were 59 males and 32 females,aged(61±10)years.Patients who were admitted from April 2004 to March 2014 underwent traditional surgical diagnosis and treatment,and patients who were admitted from April 2014 to April 2021 underwent multidisciplinary diagnosis and treatment.Observation indicators:(1)surgical situations;(2)postoperative situations;(3)postoperative pathological examinations;(4)postoperative prognosis analysis;(5)influencing factors of postoperative prognosis.Followup was conducted using telephone interview and outpatient examination.Patients were followed up once every 6 months after surgery to detect survival.The follow-up was up to April 2023.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was conducted using the independent sample t test.Measurement data with skewed distribution were represented as M(range),and comparison between groups was conducted using the Mann-Whitney U test.Comparison of ordinal data was conducted using the rank sum test.Count data were described as absolute numbers or percentages,and comparison between groups was conducted using the chi-square test or Fisher exact probability.The Kaplan-Meier method was used to draw survival curve and calculate survival rate.The Log-Rank test was used for survival analysis.Univariate and multivariate analyses were conducted using the COX proportional hazard model.Results(1)Surgical situations.Of the 91 patients,there were 65 cases receiving hemi-or expanded hemihepatectomy,13 cases receiving tri-hepatectomy,9 cases receiving partial hepatectomy,4

关 键 词：胆道肿瘤 肝门部 多学科团队 手术切除 预后因素 

分 类 号：R735.8[医药卫生—肿瘤]