年龄校正的Charlson合并症指数与肝门部胆管癌患者腹腔镜手术切除后预后的关系  

The relationship of age-adjusted Charlson comorbidity index and prognosis of patients undergoing laparoscopic resection for hilar cholangiocarcinoma

作　　者：蔡驰宇 王连才 陶连元 李冬筱 肖二卫 田广金 罗冠彬 闫壮壮 王艳勃 李德宇 Cai Chiyu;Wang Liancai;Tao Lianyuan;Li Dongxiao;Xiao Erwei;Tian Guangjin;Luo Guanbin;Yan Zhuangzhuang;Wang Yanbo;Li Deyu(Department of Hepatobiliary and Pancreatic Surgery,Zhengzhou University People's Hospital,Zhengzhou 450003,China;Department of Gastroenterology,Zhengzhou University People's Hospital,Zhengzhou 450003,China;Department of Hepatobiliary and Pancreatic Surgery,Henan University People's Hospital,Zhengzhou 450003,China)

机构地区：[1]郑州大学人民医院肝胆胰腺外科,郑州450003 [2]郑州大学人民医院消化内科,郑州450003 [3]河南大学人民医院肝胆胰腺外科,郑州450003

出　　处：《中华肝胆外科杂志》2024年第1期33-37,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：河南省科技攻关计划项目(212102310132);河南省医学科技攻关计划(联合共建)项目(LHGJ20190578)。

摘　　要：目的:分析年龄校正的Charlson合并症指数(ACCI)对肝门胆部管癌患者腹腔镜手术切除后预后的影响。方法:回顾分析郑州大学人民医院2013年1月至2018年1月行腹腔镜手术切除的136例肝门部胆管癌患者资料,其中男性81例,女性55例,年龄(63.6±9.8)岁。根据ACCI中位数4.0将所有患者分为高ACCI组(ACCI>4.0, n=49)和低ACCI组(ACCI≤4.0, n=87)。比较两组预后。单因素和多因素Cox回归分析ACCI对患者腹腔镜手术切除后生存的影响。 结果:低ACCI组患者术后1、3年累积生存率分别为87.4%、48.3%,高ACCI组分别为53.1%、4.1%,低ACCI组术后累积生存率高于高ACCI组,差异有统计学意义(χ^(2)=27.97, P<0.001)。单因素Cox回归分析ACCI>4.0与生存预后相关( HR=3.73,95% CI:2.44~5.68, P<0.001)。多因素Cox回归分析也显示ACCI>4.0( HR=2.69,95% CI:1.65~4.37, P<0.001)的肝门部胆管癌患者腹腔镜手术切除后死亡风险增加。 结论:ACCI是肝门部胆管癌患者腹腔镜手术切除后生存的危险因素,为术前精准评估患者状态及术式选择提供参考。Objective To study the impact of the age-adjusted Charlson comorbidity index(ACCI)on the prognosis of patients with hilar cholangiocarcinoma following laparoscopic surgical resection.MethodsClinical data of 136 patients with hilar cholangiocarcinoma undergoing laparoscopic surgery at Zhengzhou University People's Hospital between January 2013 and January 2018 were retrospectively analyzed,including 81 males and 55 females,aged(63.6±9.8)years.Patients were divided into two groups based on the median ACCI score of 4.0:the high ACCI group(ACCI>4.0,n=49)and low ACCI group(ACCI≤4.0,n=87).The prognosis was compared between the two group.Univariate and multivariate Cox regression analyses were performed to analyze the effect of ACCI on survival after laparoscopic surgery.ResultsThe 1-and 3-year cumulative survival rates in low ACCI group were 87.4%and 48.3%,respectively,compared to 53.1%and 4.1%in high ACCI group(χ^(2)=27.97,P<0.001).Univariate Cox regression analysis indicated that ACCI>4.0 was associated with prognosis(HR=3.73,95%CI:2.44-5.68,P<0.001).Multivariate Cox regression analysis also indicated that ACCI>4.0 was associated with an increased risk of postoperative mortality in patients with hilar cholangiocarcinoma(HR=2.69,95%CI:1.65-4.37,P<0.001).ConclusionThe ACCI is a significant risk factor for survival of patients with hilar cholangiocarcinoma following laparoscopic surgery,which could facilitate a precise preoperative assessment of patient status and choice of surgical approach.

关 键 词：Klatskin肿瘤 预后 影响因素 年龄校正的Charlson合并症指数 

分 类 号：R735.8[医药卫生—肿瘤]