170例Ⅲ型肝门胆管癌的治疗及预后分析

目的探讨Ⅲ型肝门胆管癌的治疗及其预后的影响因素。方法回顾性分析2002年1月至2011年12月期间笔者所在医院收治的170例Ⅲ型肝门胆管癌患者的临床资料。结果170例患者中，行手术切除60例，行姑息性支架或u管支撑引流49例，行经皮经肝胆管外引流14例，未治疗47例。60例手术切除患者中，R0切除50例，R1切除10例。手术切除患者预后影响因素的Cox比例风险模型结果显示，手术切缘（HR=4．621，95％ CI：1．907-11．199，P=0．001）、肝叶切除（HR=3．003，95％ CI：1．373-6．569，P=0．006）及淋巴结转移（HR=2．792，95％ CI：1．393-5．598，P=0．004）与预后均相关。所有患者预后影响因素的Cox比例风险模型结果显示，治疗方法【R0切除（HR=0．177，95％ CI：0．081-0．035，P〈0．001），未治疗（舰=5．568，95％ CI：2．733-11．342，P〈0．001）]及血管侵犯（HR=I．667，95％ CI：1．152-2．412，P=-0．007）与预后均相关。结论治疗方式与血管是否受侵犯与Ⅲ型肝门胆管癌的预后相关；可行手术切除患者中联合肝叶切除、R0切除及无淋巴结转移者的预后相对较好。

Treatment and Prognostic Factor of Type III Hilar Cholangiocarcinoma in 170 Cases

Objective To explore the treatment and prognostic factors of type III hilar cholangiocarcinoma. Methods The data of 170 cases of type Ill hilar cholangiocarcinoma treated in our hospital from Jan. 2002 to Dec. 2011 were retrospectively analyzed. Results Among these 170 patients of type ]If hilar cholangiocarcinoma, 109 patients underwent surgical exploration in which 60 patients underwent resection and the remaining 49 patients were found unresec- table and underwent U-tube or metallic stent drainage. Sixty one patients were preoperatively assessed as unresectable in which 14 patients underwent percutaneous transhepatic cholangial drainage and the remaining 47 patients refused any surgical intervention. Results of Cox proportional hazard model showed that residual tumor status （HR：4. 621, 95% CI： 1. 907-11. 199, P：0. 001）, lymph node metastasis （HR：2. 792, 95% CI： 1. 393-5.598, P：0. 004）, and hepatectomy （HR=3. 003, 95% CI. 1. 373-6.569, P：0.006） were independent prognostic factors which associated with patients in resection group. Besides, treatment [R0 resection （HR：0. 177, 95% CI： O. 081-0. 035, P〈0. 001）, no treatment HR= 5.568, 95% CI： 2.733-11.342, P〈0. 001）] and vascular invasion （HR：I. 667, 95% CI： 1. 152-2. 412, P=0. 007） were prognostic factors associated with all patients. Conclusions Treatment and vascular invasion are the most important predictors of prolonging survival associated with type Ⅲ hilar cholangiocarcinoma. Besides, R0 resection including hepa-tectomy without lymph nodes metastasis is feasible in the majority of patients with resectable hilar cholangiocarcinoma.