伴神经浸润的肝门部胆管癌的病理和临床分析

目的总结伴神经浸润的肝门部胆管癌的临床病理类型、手术方式,探讨伴神经浸润的肝门部胆管癌治疗方法及远期存活率。方法对1993年1月至2004年12月收治的311例肝门部胆管癌(神经浸润组89例、无神经浸润组222例)的临床病理及随访资料进行回顾性分析。结果神经浸润是肝门部胆管癌的一种重要转移方式。伴神经浸润组的89例肝门部胆管癌的1、3、5年存活率分别为65.59%、22.71%、14.83%,无神经浸润组的222例肝门部胆管癌的1、3、5年存活率分别为80.62%、35.14%、24.98%,无神经浸润组存活率明显高于神经浸润组(P=0.037)。结论肿瘤的分化程度、手术方式是影响预后的重要因素。根治性切除是目前较理想的治疗方式。伴神经浸润的肝门部胆管癌患者的预后较差,远期疗效仍无显著改善,根治性切除术可望改善其预后。

Clinicopathologic analysis of hilar cholangiocarcinoma with nerve invasion

Objective To investigate the pathologic types and surgical procedures,treatments and long-term survival rate of hilar cholangiocarcinoma with nerve invasion.Methods The clinical data of 311 patients with hilar cholangiocarcinoma (hilar cholangiocarcinoma with nerve invasion in 89 and hilar cholangiocarcinoma without nerve invasion in 222) treated in our hospital from Jan.1993 to Dec.2004 were analyzed retrospectively.Results Nerve invasion was one of the most important metastasis manners of hilar cholangiocarcinoma.The 1-,3-and 5-year survival rate of 89 cases of hilar cholangiocarcinoma with nerve invasion was 65.59%,22.71% and 14.83%,respectively,while that in 222 cases of hilar cholangiocarcinoma without nerve invasion was 80.62%,35.14% and 24.98% (P=0.037).Conclusion Pathologic types and surgical procedures were the significant risk factors influencing prognosis of hilar cholangiocarcinoma with nerve invasion.At present,radical resection is the only reasonable procedure for these patients.