摘要
目的探讨肝门部胆管癌外科治疗的预后影响因素。方法采用回顾性病例对照研究方法。收集2010年1月至2017年12月北部战区总医院收治的93例行外科治疗肝门部胆管癌患者的临床病理资料;男61例,女32例;年龄为(64±8)岁,年龄范围为43~84岁。根据肝门部胆管癌不同术前分型及术中探查情况施行相应手术。观察指标:(1)手术治疗情况。(2)肿瘤分型和分期以及分化程度:①肿瘤分型和分期;②肿瘤分化程度。(3)随访情况。(4)预后影响因素分析:①单因素分析;②多因素分析。(5)亚组分析。采用门诊和电话方式进行随访,随访内容为患者生存时间和生存率。随访时间截至2017年12月31日。采用Kaplan-Meier法计算生存时间及生存率,并绘制生存曲线;采用Log-rank检验进行生存情况分析。单因素分析采用Log-rank检验,多因素分析采用COX比例风险模型。结果(1)手术治疗情况:93例患者均行手术治疗,其中51例行根治性切除术;23例行姑息性切除术;16例行胆管内引流或外引流;3例行剖腹探查术及术中活组织检查。(2)肿瘤分型和分期以及分化程度,①肿瘤分型和分期:93例肝门部胆管癌患者中,Bismuth-Corlette分型为Ⅰ型26例,Ⅱ型22例,Ⅲa型9例,Ⅲb型18例,Ⅳ型18例;TNM分期为Ⅰ期7例,Ⅱ期34例,Ⅲ期22例,Ⅳ期30例;MayoClinic分期为1期20例,2期19例,3期51例,4期3例。②肿瘤分化程度:病理学检查结果显示93例患者肝门部胆管癌肿瘤分化程度中,高、中、低、黏液腺癌及乳头状腺癌分别为16、35、37、4、1例。(3)随访情况:93例患者均获得随访,随访时间为6~36个月,中位随访时间为24个月。93例患者生存时间为(21.4±2.1)个月。患者术后1、2、3年总体生存率分别为62.2%、34.9%、17.1%。(4)预后影响因素分析:①单因素分析结果显示:术前总胆红素水平、术前CA19-9水平、术前CA24-2水平、手术方式、淋巴结转移、血管侵犯、TNM分期�
ObjectiveTo analyze the prognostic factors in the surgical treatment of hilar cholangiocarcinoma. MethodsThe retrospective case-control study was conducted.The clinicopathological data of 93 patients [61 males and 32 females, age (64±8)years with the range of 43-84 years] with hilar cholangiocarcinoma who underwent surgical treatments in the General Hospital of the Northern Theater from January 2010 to December 2017 were collected.According to preoperative different staging and intraoperative exploration of hilar cholangiocarcinoma,corresponding operations were performed. Observation indicators:(1)surgical treatment situations;(2)tumor typing, staging and degree of differentiation:①tumor typing and staging,②degree of tumor differentiation;(3)follow-up situations;(4)analysis of prognostic factors:①univariate analysis,②multivariate analysis;(5)subgroup analysis. Follow-up using outpatient examination and telephone interview was performed to detect survival time and survival rate of patients up to December 31, 2017. Kaplan-Meier method was used to calculate survival time and survival rate and to draw survival curves. Survival situations were analyzed by Log-rank test. The univariate analysis and multivariate analysis were performed using the Log-rank test and COX proportional hazard model respectively. Results(1)Surgical treatment situations: 93 patients underwent surgical treatments, including 51 undergoing radical resection, 23 undergoing palliative resection, 16 undergoing internal biliary drainage or external drainage,3 undergoing abdominal laparotomy and intraoperative biopsy.(2)Tumor typing, staging and degree of differentiation.①Tumor typing and staging: of the 93 patients with hilar cholangiocarcinoma, Bismuth-Corlette type Ⅰ,Ⅱ,Ⅲa,Ⅲb and Ⅳ were detected in 26,22,9,18 and 18 patients. TNM stage Ⅰ,Ⅱ,Ⅲ and Ⅳ were detected in 7,34,22 and 30 patients, Mayo Clinic stage 1,2,3,4 were detected in 20,19,51 and 3 patients.②Degree of tumor differentiation: results of pathological examinat
作者
倪传斗
宋春峰
杨明军
邢鹏
张巍
Ni Chuandou;Song Chunfeng;Yang Mingjun;Xing Peng;Zhang Wei(Department of Hepatobiliary Surgery,the General Hospital of the Northern Theater,Shenyang 110016,China;Department of General Surgery,the First People's Hospital of Wenling,Taizhou 317500,Zhejiang Province,China Corresponding author:Zhang Wei,Email,zhang wei_1980@163.com)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2019年第1期83-90,共8页
Chinese Journal of Digestive Surgery
基金
国家自然科学基金青年基金(31401215)
辽宁省自然科学基金面上项目(2015020401)
中国博士后科学基金面上项目(2015M582884).
关键词
肝门部胆管癌
外科手术
肿瘤分型
肿瘤分期
肿瘤分化程度
预后分析
Hilar cholangiocarcinoma
Surgical procedures,operative
Tumor typing
Tumor staging
Degree of tumor differentiation
Prognosis analysis
