【摘要】 目的探讨肝内胆管结石罹患胆管癌的预后因素。方法回顾分析我院2006年1月~2017年2月肝内胆管结石中26例罹患胆管癌(病例组)和386例非胆管癌(对照组)的临床资料,采用单因素和logistic回归模型多因素分析肝内胆管结石罹患胆管癌的预后因素。结果单因素分析结果显示,肝脓肿、肝硬化、门静脉高压、病肝切除、胆管狭窄矫正、结石完全清除2组差异有显著性(P<0.05)。病例组胆管狭窄发生率57.7%(15/26),高于对照组38.3%(148/386),但差异无统计学意义(χ~2=3.815,P=0.051)。logistic回归模型多因素分析显示肝硬化(OR=4.873,95%CI:1.310~18.126,P=0.018)、结石残留(OR=27.579,95%CI:6.275~121.214,P=0.000)为肝内胆管结石罹患胆管癌的独立预后因素,胆管狭窄矫正(OR=0.018,95%CI:0.092~0.564,P=0.000)为独立保护因素。结论在治疗肝内胆管结石的过程中,要做到早发现早治疗,及时控制感染,积极地进行手术,预防肝脓肿、肝硬化及门静脉高压的发生,同时尽可能彻底清除结石,纠正胆管狭窄,切除病肝。更多还原

【Abstract】 Objective To analyze the prognostic factors of hepatolithiasis with cholangiocarcinoma. Methods Clinical data of hepatolithiasis with( case group,n = 26) and without( control group,n = 386) cholangiocarcinoma in our hospital from January2006 to February 2017 were reviewed. Univariate analysis and logistic regression analysis were applied to analyze the prognostic factors of hepatolithiasis with cholangiocarcinoma. Results Univariate analysis showed that there were significant differences between the two group in hepatic abscess,liver cirrhosis,portal hypertension,morbid hepatectomy,clearance of stones,and correction of biliary stricture( P < 0. 05). The was no significan difference in the incidence of biliary stricture between the two groups[the case group:55. 7%( 15/26) vs. the control group: 38. 3%( 148/386),χ~2= 3. 815,P = 0. 051]. Logistic regression analysis illustrated that liver cirrhosis( OR = 4. 873,95% CI: 1. 310-18. 126,P = 0. 018) and residual stones( OR = 27. 579,95% CI: 6. 275-121. 214,P =0. 000) were independent prognostic factors. The biliary stricture correction( OR = 0. 018,95% CI: 0. 092-0. 564,P = 0. 000) was an independent protective factor. Conclusions For the hepatolithasis management,every effort should be made to achieve early detection and treatment,which could prevent liver abscess,liver cirrhosis and portal hypertension. Clearance of stones,correction of stenosis,and morbid hepatectomy should be applied during the operation.更多还原