【摘要】 目的探讨影响外科治疗肝门部胆管癌(HCCA)患者预后的因素。方法 2010年1月~2014年1月收治的HCCA患者120例,行手术切除者67例【其中行根治性切除30例,姑息性切除(R1,R2)37例】和行胆管引流术53例(内引流术30例,外引流术23例)。结果 120例HCCA患者术后1 a、2 a、3 a生存率分别为67.5%(81/120)、45.8%(55/120)、25.0%(30/120),其中根治性切除患者1 a、2 a、3 a生存率分别为93.33%、73.33%、60.00%,生存时间为(30.26±5.26)m,显著高于姑息性切除患者的(67.57%、48.65%、32.43%)和(22.14±4.78)m或胆管引流术患者【(52.83%、28.30%、0.0%)和(15.21±3.74)m,P<0.05】,姑息性切除患者上述指标又显著高于胆管引流术患者(P<0.05);COX多因素分析显示,手术方式、切缘情况、细胞分化程度、TNM分期、淋巴结转移和门静脉侵犯均为影响HCCA患者外科治疗后生存的独立危险因素(P<0.05)。结论影响HCCA患者治疗后预后的因素较多,应针对性地做出评估,给予合理的治疗,以使患者最大获益。更多还原

【Abstract】 Objective To investigate the influencing factors of prognosis in patients with hilar cholangiocarcinoma(HCCA) after surgical treatment. Methods 120 patients with HCCA were recruited in our hospital between January 2010 and January 2014,and 67 patients received surgical resection,including 30 with radical resection and 37 with R1 or R2 palliative resection,and 53 received bile duct drainage. Results The 1-year,2-year and 3-year survival rates in the 120 patients with HCCA were 67.5%(81/120),45.8%(55/120) and25%(30/120),respectively,after treatment,and the 1-year,2-year and 3-year survival rates in patients undergoing radical resection were 93.33%,73.33%,60.00%,and the survival time was(30.26±5.26) months,much higher than67.57%,48.65%,32.43% or longer than(22.14±4.78) m in patients with palliative resection or 52.83%,28.30%,0.0% and(15.21±3.74) m in patients with bile duct drainage(P<0.05);Cox multivariate analysis showed that the surgical method [Exp(β)=5.214],resection margin [Exp(β)=2.703],differentiation degree [Exp(β)=4.781],TNM stage [Exp(β)=6.987],lymph node metastasis [Exp(β)=2.751] and portal vein invasion [Exp(β)=3.254] were the independent risk factors for the prognosis of patients with HCCA after treatment(P <0.05). Conclusion Precise surgery should be given in patients with HCCA with detailed analysis of influencing factors of prognosis, which might be evaluated before any approaches is taken.更多还原