老年人肝门部胆管癌的手术治疗方式探讨

目的探讨手术治疗老年患者肝门部胆管癌的方法。方法将经手术治疗的54例肝门部胆管病例按年龄分为70岁及以上组(A组32例)和70岁以下组(B组22例),对两组临床资料、手术方式、手术并发症及随访资料等进行回顾对比分析。结果本组总切除率为51.9%(28/54),其中根治性切除(R0)率为53.6%(15/28),姑息性切除(R1,R2)率为46.4%(13/28)。A组、B组切除率分别为53.1%(17/32)与50.0%(11/22),差异有统计学意义(χ2=2.98,P=0.08),根治性切除率分别为52.9%(9/17)与54.5%(6/11),差异无统计学意义(χ2=0.006,P=0.93),局部切除比例分别为82.4%(14/17)与54.5%(6/11),差异亦无统计学意义(χ2=2.53,P=0.11),局部切除获根治率分别占57.1%(8/14)与50.0%(3/6),差异有统计学意义(χ2=0.09,P=0.77)。术后两周血清总胆红素与术前相比较,A组(t=5.19,P=0.000)、B组(t=3.67,P=0.007)差异均有统计学意义,但A组与B组比较,术前(t=1.52,P=0.14)与术后(t=0.69,P=0.49)血清胆红素均差异无统计学意义。A组、B组术后发生并发症分别为13例(13/32,40.6%)、6例(6/22,27.3%),两组比较差异无统计学意义(χ2=1.02,P=0.31)。R0切除的中位生存时间为(38.0±9.6)个月,姑息切除为(11.0±2.5)个月,姑息引流为(6.0±3.0)个月,三者间差异均有统计学意义(χ2=11.03,P=0.004),但A组与B组的整体生存率差异无统计学意义(χ2=0.27,P=0.60)。结论年龄不是影响肝门部胆管癌切除与否的因素,局部切除是老年患者外科治疗的首选方式。

Surgical treatment for eldly hilar cholangiocarcinoma

Objective To investigate the methods of surgical treatment for eldly hillar cholangiocarcinoma.Methods Fifty-four patients of hillar cholangiocarcinoma were divided into two groups:group A(n=32,70 years old or older) and group B(n=22,younger than 22 years old).The clinical data,surgical procedures and complications,follow-up data were analyzed and compared between the two groups.Results All the patients were treated surgically.The total excision rate was 51.9%(28/54),with radically excision rate(R0) of 53.6%(15/28),and palliative excision rate(R1,R2) of 46.4%(13/28).The excision rate of group A and group B were 53.1%(17/32) and 50.0%(11/22),respectively,showing statistically significant difference(χ2=2.98 P=0.08).No statistically significant difference was found between the two groups in radically excision rates and local excision rates,52.9%(9/17) and 82.4%(14/17) for group A and 54.5%(6/11) and 54.5%(6/11) for group B(χ2=0.006 P=0.93;χ2=2.53,P=0.11),while statistically significant difference was found in gained radically excision cases 57.1%(8/14) and 50.0%(3/6),respectively(χ2=0.09 P=0.77).Two weeks after surgery,statistically significant different was found in totally serum bilirubin of group A(t=5.19,P=0.000) and group B(t=3.67,P=0.007) compared with that before surgery,but not between the two groups preoperatively(t=1.52,P=0.14) and postoperatively(t=0.69,P=0.49).13 cases showed complications in group A(13/32,40.6%) and 6 cases(6/22,27.3%) in B group,with no statistically significant different(χ2=1.02,P=0.31).The median survival time was(38.0±9.6) months in R0 excision group,(11.0±2.5) months in palliative excision group,(6.0±3.0) months in drainage group,with statistically significant difference between the three groups(χ2=11.03,P=0.004).But no statistically significant difference was found in the total survival rates between the two groups(χ2=0.27,P=0.60).Conclusion Age is not the influence factor for the resection of eldly hillar cholangiocarcinoma.Local resection is proved to be the premium choice for surgical treatment.