肝内胆管结石相关性肝内胆管细胞癌的临床病理特征及预后分析  

Analysis of clinicopathological and prognostic characteristics in hepatolithiasis-associated intrahepatic cholangiocarcinoma

作　　者：宿鑫成 庞书杰 杨宁[1] 许朱定[2] 张海斌[1] 付雍[1] 杨广顺[1] 

机构地区：[1]第二军医大学附属东方肝胆外科医院肝外五科,上海200438 [2]解放军第359医院普外科,江苏镇江212001

出　　处：《江苏大学学报（医学版）》2015年第3期241-245,共5页Journal of Jiangsu University：Medicine Edition

基　　金：国家十二五艾滋病和病毒性肝炎等重大传染病防治专项课题(2012ZX10002-017)

摘　　要：目的:研究肝内胆管结石相关性肝内胆管细胞癌(intrahepatic cholangiocarcinoma,ICC)的临床病理特征和预后特点。方法:收集296例首次行根治性手术治疗的ICC患者资料,按有无合并肝内胆管结石分为两组,其中结石阳性组38例,结石阴性组258例。对两组患者16项临床病理特点以及术后无瘤生存时间和总生存时间等数据进行回顾性对比分析。结果:结石阳性组平均年龄和女性比例、临床症状阳性率、CA19-9、碱性磷酸酶、γ谷氨酰胺转肽酶水平均明显高于结石阴性组,而且,结石阳性组的患者肿瘤更易形成子灶、淋巴结转移、神经侵犯,TNM分期更晚。结石阳性组患者1,3,5年无瘤生存率分别为19.8%,2.6%,0%,明显低于结石阴性组(46.9%,26.4%,20.9%)。结石阳性组ICC患者的1,3和5年生存率为39.5%,7.9%和0%,也明显低于结石阴性组ICC患者(67.8%,38.0%,26.4%)。结论:合并肝内胆管结石的ICC患者肿瘤分期更晚,易发生淋巴结转移,预后更差,术中应行肝十二指肠韧带内淋巴结清扫。Objective: To describe the difference between the hepatolithiasis( HL)-positive intrahepatic cholangiocarcinoma( ICC) and hepatolithiasis-negative intrahepatic cholangiocarcinoma,and examine the prognosis based on our data. Methods: A total of 296 patients with ICC underwent the first curative resection were involved in our research,in whom 38 were with hepatolithiasis,the rest 258 were without. Data of sixteen clinicopathological features,recurrence free survival( RFS) rate and overall survival( OS) rate were collected and examined retrospectively. Results: About the sixteen clinicopathological features,the age of the HL-associated ICC patients tend to be older and with more female gender. The HL-positive group tends to have a higher level of CA19-9,ALP,r-GT. Meanwhile,the HL-positive ICC was more likely to be accompanied with satellite lesions,lymph node metastasis,nerve invasion. Moreover,the HL-positive ICC tends to have a more progressive TNM staging. The actual 1-,3-,5-year recurrence free survival( RFS) rate in the HL-positive group was 19. 8%,2. 6%,0% and in the HL-negative group was 46. 9%,26. 4%,20. 9%. The 1-,3-,and 5-year overall survival rate was 39. 5%,7. 9%,0% in the HL-positive group and in the HL-negative group was 67. 8%,38. 0%,26. 4%. Conclusion: The HL-positive ICC has a more progressive degree and a poorer prognosis compared with the HL-negative ICC. So that the HL-positive ICCwere prone to form the lymph node metastasis,and lymphadenectomy in the hepatoduodenal ligament was suggested.

关 键 词：肝内胆管细胞癌 肝内胆管结石 预后 生存率 

分 类 号：R735.8[医药卫生—肿瘤]