肝门部胆管癌手术疗效与安全性的影响因素分析  

Factors influencing the efficacy and safety of surgery for hilar cholangiocarcinoma

作　　者：杨大龙 陆海明 钟鉴宏[1,3] 齐鲁楠 陈祖舜[1,3] 向邦德 黎乐群[1,3] 马良 YANG Dalong;LU Haiming;ZHONG Jianhong;QI Lunan;CHEN Zushun;XIANG Bangde;LI Lequn;MA Liang(Hepatobiliary Surgery Department,Guangxi Medical University Cancer Hospital,Nanning 530021,China;Emergency Medicine Department,Liuzhou People′s Hospital,Liuzhou 545000,China;Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center,Nanning 530021,China)

机构地区：[1]广西医科大学附属肿瘤医院肝胆胰脾外科,南宁530021 [2]柳州市人民医院急诊医学科,柳州545000 [3]广西肝癌诊疗工程技术研究中心,南宁530021

出　　处：《中国癌症防治杂志》2023年第6期644-649,共6页CHINESE JOURNAL OF ONCOLOGY PREVENTION AND TREATMENT

基　　金：国家自然科学基金项目(82260569);广西中医药适宜技术开发与推广项目(GZSY23⁃66)。

摘　　要：目的探讨肝门部胆管癌(hilar cholangiocarcinoma,HC)切除术后发生≥Ⅲa级并发症及总生存期(overall survival,OS)的影响因素。方法回顾性分析2010年6月至2022年3月在广西医科大学附属肿瘤医院收治的62例行手术切除的HC患者的临床资料。采用logistic回归分析切除术后发生≥Ⅲa级并发症的危险因素,Cox回归分析影响OS的因素。结果HC患者术后并发症发生率为73.5%(36/49),其中≥Ⅲa级并发症的发生率为46.9%(23/49),围手术期死亡率为10.2%(5/49)。术中出血量>500 mL、AJCC分期Ⅲ/Ⅳ期是HC患者术后发生≥Ⅲa级并发症的独立危险因素(均P<0.05)。HC患者术后中位OS为24.0个月,1、3、5年总生存率分别为73%、49%和20%。术前CA19⁃9≥150 U/L以及全尾状叶切除是影响患者术后OS的独立因素(均P<0.05)。结论AJCC分期Ⅲ/Ⅳ期和手术出血>500 mL是HC术后≥Ⅲa级围手术期并发症的危险因素,术前CA19⁃9≥150 U/L是术后OS的危险因素,全尾状叶切除是术后OS的保护因素。Objective To investigate the risk factors of surgical complications of grade≥Ⅲa and the overall survival rate of hilar cholangiocarcinoma(HC)after resection.Methods The clinical data of 62 patients with HC who underwent surgical resection in the Guangxi Medical University Cancer Hospital from June 2010 to March 2022 were retrospectively analyzed.The risk factors of postoperative complications of grade≥Ⅲa were analyzed by virtue of logistic regression analysis,and cox regression model was used to analyze the factors influencing overall survival.Results The incidence of postoperative complications in HC patients was 73.5%(36/49),among which the incidence of≥Ⅲa complications and the perioperative mortality accounted for 46.9%(23/49)and 10.2%(5/49),respectively.Intraoperative blood loss>500 mL and AJCC stageⅢ/Ⅳwere independent risk factors for postoperative complications grade≥Ⅲa in HC patients(all P<0.05).The median survival of HC patients was 24.0 months,and the 1⁃year,3⁃year and 5⁃year overall survival rates were 73%,49%and 20%,respectively.Preoperative CA19⁃9≥150 U/L and total caudate lobed resection were independent factors affecting the overall survival rate(all P<0.05).Conclusions AJCC stageⅢ/Ⅳand intraoperative blood loss>500 mL are risk factors for perioperative complications≥gradeⅢa after HC resection.Preoperative CA19⁃9≥150 U/L is a risk factor for postoperative overall survival,and total caudate lobectomy is a protective factor for postoperative overall survival.

关 键 词：肝门部胆管癌 手术切除 并发症 总生存期 

分 类 号：R735.8[医药卫生—肿瘤]