肝门部胆管癌切除术后影响生存率的因素分析

目的探讨影响肝门部胆管癌切除术后生存率的因素。方法回顾性分析2001年1月至2009年12月期间收治的行手术治疗肝门部胆管癌60例的临床资料,分析影响其术后生存率的因素。结果本组行手术切除55例,无法切除5例。R0切除40例,R1切除12例,R2切除3例,围手术期死亡1例。R0切除者中位生存时间,高于R1、R2切除者;淋巴结无转移者的中位生存时间,高于有淋巴结转移者;Ⅰ~Ⅱ期病人中位生存时间,高于Ⅲ~Ⅳ期病人;高分化肿瘤病人中位生存时间,高于中、低分化肿瘤病人;肿瘤无远处转移者中位生存时间,优于有远处转移者;无血管侵犯者中位生存时间,优于有血管侵犯者;行胆管单纯切除者中位生存时间,低于行半肝或扩大半肝+尾状叶切除者,以上各项间差异均有统计学意义(P0.05)。多因素分析表明,切缘阴性(R0切除)是影响生存时间的唯一独立因素。结论手术方式,肿瘤切缘、分期、细胞分化程度,有否淋巴结转移、远处转移和血管侵犯等与肝门部胆管癌术后生存率相关。根治性切除(R0切除)是影响肝门部胆管癌长期生存率的主要及决定因素。

Survival rate of hilar cholangiocarcinoma after resection

Objective To explore factors that influenced the survival rate of hilar cholangiocarcinoma after surgical excision. Methods A 8-year（from January 2001 to December 2009）review of 60 patients with hilar cholangiocarcinoma treated surgically at a single surgical unit was conducted. Factors that influenced the survival rate of hilar cholangiocarcinoma after surgical excision were analyzed. Results Out of 60 patients,55 had a resection,and 5 were considered unresectable. Negative histologic margins（R0 ）were achieved in 41） patients and microscopic margin involvement（R1 ）was seen in 12. The remaining 3 patients were subjected to palliative resection（R2 ）. One died at the 311th day after surgical resection. The median survival time in R0 group was 41 months,which was significantly longer than in R1 and R2 groups（P〈0. 05）. The median survival time in patients with no lymph node metastases was longer than in those with lymph node metastases（P〈0. 115）. The median survival time in stage Ⅰ-Ⅱ groups was longer than in stage Ⅲ- Ⅳgroups（P〈0. 05）. The median survival time in well differentiated groups was longer than in moderately differentiated groups and poorly differentiated groups（P〈0.05）. The median survival time in patients without distant metastases of tumor was longer than in those with distant metastases of tumor（P〈0.05）. The median survival time in vascular invasion groups was longer than in no-vascular invasion groups（P〈0. 05 ）. The median survival time in simple duct resection groups was longer than in hemihepatectomy or extended hemihepatectomy ＋ caudate lobe resection groups（P〈0. 05）. Conclusion Surgical procedures, tumor margin, TNM stage, lymph node metastases, histopathologic differentiation, distant metastases, vascular invasion and other factors were correlated with survival rate of hilar cholangiocarcinoma after radical surgical excision. Radical surgical excision（R0 ）was the main and dependent factor that influenced long survival rate of hilar cholangiocarcinoma after radical surgical excision.