肝内胆管癌精索转移1例

  目的  研究分析肝内胆管癌（intrhepatic cholangiocarcinoma, ICC）的临床转移特点、治疗及预后。  方法  回顾性分析1989年1月至2009年12月本院收治的103例肝内胆管癌的临床资料, 分析根治手术与姑息手术、非手术治疗后患者预后的差异。  结果  103例肝内胆管癌患者1、3、5年总体生存率分别为66.1%, 30.1%, 18.4%, 中位生存时间20个月。根治手术组1、3、5年生存率分别为75.3%, 48.2%, 33.9%, 与姑息手术组（46.3%, 0, 0）、非手术组（7.7%, 0, 0）之间的差异有统计学意义。
单因素分析表明患者的肿瘤直径、组织学分化程度、肿瘤单发或多发、门静脉、淋巴结、腹膜转移、手术方式为影响肝内胆管癌预后的危险因素。多因素分析显示组织学分化程度、有无门静脉转移、淋巴结转移、腹膜转移及手术方式是影响预后的独立因素。  结论  ICC淋巴结转移率高, 肝内复发是导致死亡的重要因素, 根治性手术切除是ICC最有效的治疗方法。组织学分化程度、门静脉转移、淋巴结转移、腹膜转移及手术方式是影响ICC患者预后的独立危险因素。

Hepatic resection and transplantation for peripheral cholangiocarcinoma

  Objective  This study aims to assess the metastatic characteristics, different therapeutic methods, and prognostic factors of intrahepatic cholangiocarcinoma (ICC).  Methods  The clinical data of 103 ICC patients treated in our hospital from 1989 to 2009 were retrospectively analyzed, and 62 of them were successfully followed up. The SPSS l8.0 software package was used for the statistical analysis.  Results  The overall 1-, 3-, and 5-year survival rates of the 103 patients were 66.1 %, 30.1 %, and 18.4 %, respectively. The median survival time was 20 months. The 1-, 3-, and 5-year survival rates for the curative resection group were 75.
3 %, 48.2 %, and 33.9 %, respectively. These values were significantly higher than those of the palliative surgery and conservative treatment groups (P = 0.000). Based on the univariate analysis, tumor size, histological grade, number of tumors (solitary or multiple), vascular invasion, serosal invasion, lymphatic invasion, and surgical treatment were significantly related to overall survival. Moreover, the Cox multivariant survival analysis revealed that histological grade, vascular invasion, serosal invasion, lymphatic invasion, and surgical treatment were independent prognostic indicators.  Conclusion  The rate of the lymph node metastasis of ICC is high, and intrahepatic relapse is one of the main causes of death. Thus, radical resection is the most effective treatment for ICC.