混合型肝细胞-胆管细胞癌的临床特点及预后分析

目的 探讨混合型肝细胞-胆管细胞癌的临床特点并分析影响预后的因素.方法 回顾性分析1999年1月至2009年12月收治的19例混合型肝细胞-胆管细胞癌的临床资料,以Kaplan-Meier法计算生存曲线,对可能的预后危险因素进行x2检验分析.结果 19例患者术后病理诊断均为混合型肝细胞-胆管细胞癌,病灶累及肝被膜13例,侵及膈肌1例,侵犯腹膜1例,脉管瘤栓1例.同期行区域淋巴结清扫术的7例中,2例发现淋巴结转移.19例患者1、3年的生存率分别为61%和42%,肿瘤直径＞5 cm(x2=4.392,P=0.036)、有长期饮酒史(x2=11.010,P=0.001)或术中输血史(x2=4.645,P=0.031)的患者预后较差.结论 混合型肝细胞-胆管细胞癌术前难以确诊,肿瘤大小、长期饮酒史及术中输血史是影响预后的危险因素.

Clinical characteristics and prognosis of combined hepatocellular-cholangiocarcinoma

Objective To investigate the clinical characteristics and analyze prognostic risk factors of combined hepatocellular-cholangiocarcinoma. Methods The clinical data of 19 cases of combined hepatocellular-cholangiocarcinoma admitted in our hospital from January 1999 to December 2009 were analyzed retrospectively. The survival function was analyzed by Kaplan-Meier. The possible prognostic risk factors were tested by χ2-test. Results Hepatocellular-cholangiocarcinoma was diagnosed by pathology in the 19 patients, among which hepatic tunic was infiltrated in 13 cases, peritoneum involved in 1 case, intravascular cancer embolus in 1 case. At that time lymphocyte nodes metastasis in 2 cases were found by regional lymphadenectomy in 7cases. The 1-year and 3-year survival rates were 61% and 42%,respectively. Prognosis of patients with tumor size ＞ 5 cm ( χ2 = 4. 392, P = 0. 036 ), history of heavy drinking ( χ2 = 11.010, P = 0.001 ) or intraoperative blood transfusion ( χ2 = 4. 645,P = 0. 031 ) were worse than others. Conclusion It was difficult to get correct preoperative diagnosis of combined hepatocellularcholangiocarcinoma. Tumor size, history of heavy drinking and blood transfusion were all prognostic related risk factors.