摘要
目的探讨肝门部胆管癌手术治疗后影响患者生存的危险因素。方法回顾性分析2003年1月至2017年5月在我院诊断并接受手术治疗的191例患者的生存情况,选择性别、年龄、肿瘤Bismuth-Corlette分型、手术方式、手术切缘肿瘤残留状况、淋巴结转移、术前总胆红素水平、术前CA19-9水平、术前白蛋白水平、血管侵犯、肿瘤病理分化程度、神经侵犯情况及术后化疗等潜在的影响预后因素进行单因素分析,再通过COX回归模型进行多因素分析。结果单因素分析显示单纯行引流手术、非R0切除、存在淋巴结转移、术前总胆红素水平≧171mmol/l、病理分化程度较差的患者预后较差(P <0. 05);多因素分析表明,对行肿瘤切除的患者,存在淋巴结转移(HR=1. 796,P=0. 008)、术前总胆红素水平≧171mmol/l(HR=1. 766,P=0. 021)和非R0切除(HR=1. 585,P=0. 030)是影响肝门部胆管癌术后生存的独立危险因素。对于非R0切除及存在淋巴结转移的患者,术后辅助化疗可以延长该类患者的生存时间。结论手术切除肿瘤能延长肝门部胆管癌患者的生存时间。肝门部胆管癌切除术后的预后受手术切缘、淋巴结转移、术前总胆红素水平、病理分化程度等多种因素影响。在联合肝叶切除的基础上,联合尾状叶切除可延长患者术后生存时间,对于非R0切除及局部淋巴结转移的患者,术后辅助化疗可以延长该类患者的生存时间。
Objective Hilar Cholangiocarcinoma is a common malignant tumor in biliary system with poor prognosis. The study aims to explore the prognosis factors of hilar cholangiocarcinoma after Surgery. Methods One hundred and ninety-one cases of patients with hilar cholangiocarcinoma after surgery in Sun Yat-sen memorial hospital of Sun Yat-sen University from January 2003 to May 2017 were selected and analyzed retrospectively. Univariate analysis was performed to assess potential prognosis factors including patients' gender, age, Bismuth-Corlette classification, surgical method, condition of incisal margin, lymph node metastasis, preopera - tive total bilirubin, preoperative CA 19-9 level, preoperative albumin level, vessel invasion, classification of tumor differentiation, nerve invasion and postoperative chemotherapy. Multivariate analysis was performed by Cox proportional hazards regression model. Results :Univariate analysis revealed that the survival of patients with simple tlrainage, positive incisal margin, lymph node metastasis, high preoperative total bilirul)in( M 171 in mol/1), poor differentiati on was significant worse ( P < 0. 05 ). Multivariate analysis revealed that lymph node metastasis( HR = 1.796,P = 0. 008), high preoperative total bilirubin(≥171mmol/l)(HR = 1.766,P =0. 021 ) and positive incisal margin (HR = 1.585 =0. 030) were the independent risk factors for patients with hilar cholangiocarcinoma after resection. Chemotherapy could improve the survival time of patients with and positive incisal margin and lymph node metastasis. Conclusion :Resection of the tumor is critical for the survival of patients with hilar cholangiocarcinoma. Incisal margin, lymph node metastasis, preoperative total bilirubin and classification of tumor differentiation were the prognosis factors of hilar cholangiocarcinoma after surgery. Combined resection of the caudate lobe could improve the survival time. Chemotherapy could improve the survival time of patients with positive incisal margin and lymph node metastasis.
作者
冯铭彬
余先焕
许磊波
唐启彬
王捷
刘超
FENG Ming-bin;YU Xia-huan;XU Lei-bo(Su Yat-san Memoinal Hospital of Sun Yat-su University,Guangzhou 510120,China)
出处
《肝胆外科杂志》
2019年第1期21-27,共7页
Journal of Hepatobiliary Surgery
关键词
肝门部胆管癌
手术治疗
预后
化疗
cholangiocarcinoma
prognosis
surgical resection
chemotherapy
