摘要
目的探讨肝外胆管癌(EHCC)的临床特征、治疗方法对远期生存率的影响,研究EHCC切除术后的预后因素。方法对1995年1月至2003年12月收治的107例EHCC的临床特点、诊断、手术方式和随访结果进行回顾分析。选择对EHCC切除术后预后可能产生影响的临床因素,通过Cox比例风险模型进行多因素的预后分析。结果107例手术治疗的EHCC,根治性切除47例(其中单纯骨骼化切除7例,联合各类肝叶切除12例,联合门静脉切除重建3例,联合胰十二指肠切除25例),姑息性切除12例,内或外引流术45例,探查性手术3例。EHCC总体生存率1,3,5年生存率分别为58.2%、30.0%和13.1%。其中根治性切除1,3,5年生存率分别为72.4%、44.7%和22.7%;姑息性切除1,2,3年生存率分别为54.5%、27.3%和9.1%,无5年存活者。引流组1,2,3年生存率分别为32.1%、17.2%和8.6%,无4年存活者。根治性切除组、姑息性切除组、内或外引流组及非手术组生存率相比较,差异有统计学意义(log-rank test,χ2=15.67,P<0.001)。肿瘤的组织学类型、TNM分期、淋巴结转移、肝脏浸润、胰腺浸润、切缘癌残留、手术切除方式7个因素对预后的影响差异有统计学意义(P<0.05)。结论根治性切除是提高EHCC远期生存率及改善生活质量的关键,骨骼化切除联合肝叶切除和(或)胰十二指肠切除是提高远期疗效的重点。淋巴结转移、切缘癌残留是EHCC切除影响预后的独立因素。
Objective To explore the effect of clinical features and therapeutic methods of extrahepatic cholangiocarcinoma （EHCC） on its prospective outcome and study the prognostic factors in patients with EHCC after curative resection. Methods The clinical features, surgical therapy and follow-up results of 107 cases of EHCC treated in our hospital from January 1995 to December 2003 were retrospectively analyzed. A multivariate analysis was performed by using the Cox proportional hazard model. Results Of the 107 patients, 59 underwent surgical resection （radical resection in 47 and palliative one in 12）, 45 non-resection internal or external drainage and 3 laparotomy. Amongst the 47 patients receiving radical resection, 7 underwent skeletonization resection （SR）, 12 SR in combination with partial hepatectomy, 3 SR in combination with portal vein resection and reconstruction and 25 SR in combination with pancreaticoduodenectomy. The 1-, 3- and 5-year survival rates were 58. 2%, 30.0% and 13.1% in the overall group and 72.4%, 44.7% and 22.7% in the radical resection group, respectively. In the palliative resection group, the 1-, 2- and 3-year survival rates were 54.5%, 27.3% and 9.1%, respectively and none of the patients survived for over 5 years. In the group of non-resection internal or external drainage, the 1-, 2- and 3-year survival rates were 32.1%, 17.2% and 8. 6%, respectively and none of the patients survived for over 4 years. There was significant difference in the survival rates among these 3 groups （P〈0. 001）. The univariate analysis showed that the major significant prognostic factors influencing the survival of the patients were histological type of lesion, TNM stages, lymph node metastasis, liver involvement, pancreatic invasion, residual tumor margin and therapeutic intervention （P〈0. 05）. Conclusions The radical resection may help to improve the prognosis of EHCC. RS in combination with partial hepatectomy or/and pancreaticoduodenectomy may help in increasing the radical resection rate, which is important to prolong the survival time. After curative resection, lymph node metastasis and residual tumor margin are independent prognostic factors for EHCC.
出处
《中华肝胆外科杂志》
CAS
CSCD
2005年第9期604-608,共5页
Chinese Journal of Hepatobiliary Surgery
