摘要
目的探讨肝门部胆管癌治疗方式及疗效。方法回顾性分析2000年6月至2010年5月北京航天中心医院收治的49例肝门部胆管癌手术病例资料。分为单纯切除组、小范围切肝组与大范围切肝组,对比各组的并发症发生率。对临床病理资料进行单因素与多因素分析,检验对生存率的影响。结果单纯切除组17例,小范围切肝组10例,大范围切肝组22例,各组并发症发生率依次为23.5%(4/17),30.0%(3/10)和72.7%(16/22),后者明显高于前两组(P<0.05)。1,3,5年总生存率分别为73.2%,41.4%和21.3%,中位生存期30个月。单因素分析显示手术方式、切缘癌残留、淋巴结转移、T分期对生存率有影响(P<0.05)。多因素分析显示淋巴结转移(RR=3.787,95%CI 0.069～25.912)和切缘癌残留(RR=2.447,95%CI 1.508～3.971)是影响肝门部胆管癌手术生存率的独立危险因素(P<0.05)。结论根据肿瘤T分期、淋巴结转移等因素选择适宜的手术方式,有望获得更大的近远期疗效。
Objective To assess the therapeutic strategies and prognostic factors that could influence the clinical outcome of hilar cholangiocarcinoma（HCC）.Methods A retrospective study was conducted on 49 cases of HCC,from June 2000 to May 2010 in Aerospace Central Hospital,who were divided into bile duct resection group（BD-group）,minor hepatectomy group（MiH-group） and major hepatectomy group（MaH-group）.The complications after surgery were analyzed.Clinico-pathological data were analyzed by uni-and multivariate analyses to examine factors affecting the survival.Results There were 17 cases in BD-group,10 cases in MiH-group and 22 cases in MaH-group.The morbidity rate of each group was 23.5%（4/17）,30%（3/10）and 72.7%（16/22）,respectively.The total 1-,3-and 5-year cumulative survival rate was 73.2%,41.4% and 21.3%,and the median survival time was 30 months.The results from univariate analyses suggest that surgery,margin involvement,lymph node metastasis and T staging be significant predictors for survival rates.By multivariate analysis,only the lymph node metastasis（RR=3.787,95% CI 0.069-25.912） and margin involvement（RR=2.447,95% CI 1.508-3.971） were significantly associated with poor survival rates.Conclusion Choosing an appropriate surgical approach for HCC according to T staging and lymph node metastasis can achieve a better short-term and long-term outcome.
出处
《军事医学》
CAS
CSCD
北大核心
2012年第1期60-64,80,共6页
Military Medical Sciences
关键词
胆管肿瘤
术后并发症
肝切除术
危险因素
预后
bile duct neoplasms
postoperative complications
hepatectomy
risk factors
prognosis
