51例肝门部胆管癌外科治疗及预后分析

目的分析肝门部胆管癌的外科治疗及预后状况。方法收集宁夏医科大学总医院2007年1月至2011年9月收治的51例肝门部胆管癌病例进行回顾性分析。结果 28例行手术治疗,其中根治性切除22例,姑息性切除6例,支架引流(包括经皮肝穿胆道引流及支架内引流)19例,保守治疗4例。根治手术组术后1、3、5年生存率为87.5%、18.8%、6.3%;姑息手术组分别为60.0%、20%、0;引流组分别为40%、0、0。高、中、低分化腺癌中位生存期为29、24、14.5个月;淋巴转移阴性、淋巴转移阳性组分别为26、14个月;切缘阴性组、切缘阳性组分别为25、18个月。结论根治性切除是治疗肝门部胆管癌的有效方法,手术应做到切缘无癌残留。病理类型、淋巴结转移情况及切缘是否阳性对预后有影响。     

122例肝门胆管癌的治疗及预后分析

目的：探讨肝门胆管癌的治疗方法及其预后。方法：回顾性比较不同治疗方法的应用和效果,分析预后因素,结果：根治性切除手术组的1,2,3和5年生存率分别为92．49％,59．85％,45．06％,25．75％,非根治切除手术组分别为36．69,7．34％,3．67％,和3．57％;开腹探查的各种姑息性引流手术和非手术引流组仅有1年生存率,分别为26％和33．38％。结论：根治性切除术疗效最佳,肿瘤分化程度,手术切缘残癌及淋巴结移状况对预后有显著影响。     

肝外胆管癌的外科治疗与预后分析

目的：探讨肝外胆管癌（EHCC）的临床特征、治疗方法对远期生存率的影响,分析影响预后的相关因素.方法：对1995-01/2003-12收治的128例EHCC的临床特点、诊断、手术方式和随访结果进行回顾分析.选择对EHCC切除术后预后可能产生影响的临床因素,通过Cox比例风险模型进行多因素的预后分析.结果：107例施行了外科手术,21例非手术治疗.其中,根治性切除47例,姑息性切除12例,内或外引流术45例,探查性手术3例.EHCC整体生存率1,3,5a生存率分别为52.8%,27.2%,11.9%.其中根治性切除1,3,5a生存率分别为72.4%,44.7%,22.7%;姑息性切除1,3,5a生存率分别为54.5%,27.3%,9.1%,无5a存活者.引流组1,3,5a生存率分别为32.1%,17.2%,8.6%,无4a存活者.根治性切除组、姑息性切除组、内或外引流组及非手术组生存率相比较,差异显著（log-ranktest,P〈0.001）.肿瘤的组织学类型、TNM分期、淋巴结转移、肝脏浸润、胰腺浸润、切缘癌残留、手术切除方式7个因素对预后的影响有统计学差异（P〈0.05）.结论：根治性切除是提高EHCC远期生存率及改善生活质量的有效手段,早期诊断和治疗是提高远期疗效的关键.淋巴结转移、切缘癌残留是EHCC预后不良的独立危险因素.     

93例肝门胆管癌外科治疗与预后分析

目的 探讨肝门胆管癌的外科治疗与预后.方法 回顾性分析我院自1999年6月-2005年6月93例肝门胆管癌患者的外科治疗情况,并分析影响其预后的因素.结果 93例肝门胆管癌病人中根治性切除52例,姑息性切除21例,行外引流术9例,开腹内引流术11例.根治性手术切除组的中位生存期31个月,其他治疗组的中位生存期分别为13、7、11个月.年龄、血清总胆红素、临床分型、肿瘤分化程度及有无淋巴结转移是影响术后患者预后的重要因素.结论 肝门胆管癌的治疗以手术切除治疗为主,根治性切除治疗的预后明显优于其他.年龄、血清总胆红素、临床分型、肿瘤分化程度及有无淋巴结转移等对预后也有显著的影响.     

肝内胆管细胞癌患者的预后影响因素分析

目的:探讨肝内胆管细胞癌预后的影响因素,为临床治疗提供依据。方法:分析2000.6～2007.1月收治的53例肝内胆管细胞癌患者的临床资料。结果:53例患者中根治性手术组1、3、5年生存率为70.1%、40.3%、20.1%;R1手术组1、3年生存率为38.1%和0%,开腹探查组1、3年生存率为25.1%和0%。单因素分析显示,丙氨酸氨基转移酶、淋巴结转移、手术切除与预后相关(P<0.01);Cox比例风险模型多因素分析显示,根治性切除(P<0.01)、淋巴结转移(P<0.01)是影响预后的独立因素。结论:根治性手术切除可使患者具有较高的术后生存率。     

肝门胆管癌可切除性手术治疗评估及预后分析

目的 探讨肝门胆管癌术(HCCA)前影像学检查在可切除评估中的价值及影响切除的因素,分析患者的预后与不同手术方式的关系.方法 回顾性分析96例HCCA患者的临床影像资料,手术治疗76例,其中根治性切除(R0)42例,Rl切除8例、R2切除8例,根治切除率占全部病人的43.8%;行十二指肠镜下胆管支架内引流8例,经皮肝穿胆道外引流10例.结果 根据Bisthmuth-Corlette分型I、Ⅱ、Ⅲ、Ⅳ型HCCA分别为29例,21例,17例,29例,根治切除率分别为75.9%,52.4%,47.1%,22.6%;根治性切除组1年,3年,5年生存率分别为79.0%,61.8%,9.0%;姑息性手术组,其1年、3年、5年生存率分别为47.1%、23.5%、0%.两组1、3、5年生存率之间均具有明显的统计学差异(P<0.05).结论 影响HCCA可切除的主要因素为Bisthmuth分型,肝动脉、门静脉是否受累及有无远处转移;HCCA有效的治疗方法为根治性切除,而姑息性手术也可明显延长患者生存期.     

肝外胆管癌临床病理特征与预后的关系

目的:探讨肝外胆管癌(EHCC)临床病理特征与预后的关系. 方法:对1995-01/ 2003-12收治的128例EHCC患者的临床病理特征、手术方式和随访结果进行回顾分析. 选择对EHCC切除术后预后可能产生影响的临床因素,通过Cox比例风险模型进行多因素的预后分析. 结果:在128例EHCC中,59例施行了外科切除, 69例施行了内或外引流术和非手术治疗. 在切除组59例中,根治性切除47例,姑息性切除12例. 其中,根治性切除1,3,5 a生存率分别为72%,45%和23%;姑息性切除1和3 a生存率分别为54%和9%,无5 a存活者. 根治性切除组和姑息性切除组生存率相比较,差异显著(log-rank test,P<0.05). 肿瘤的组织学类型、TNM分期、淋巴结转移、胰腺浸润、切缘癌残留、手术切除方式对预后有重要影响(P<0.05). 结论:临床病理特征与预后有明显的相关性,根治性切除可提高EHCC的远期生存率.     

肝内胆管细胞癌的临床外科特点及预后分析

目的探讨肝内胆管细胞癌的临床外科特点及影响手术预后的因素。方法回顾性分析本院2010年1月～2015年5月收治的68例肝内胆管细胞癌患者的临床资料,采用Kaplan-Meier法计算生存率,Log-rank法比较各组间的生存差异,Cox回归分析进行多因素分析。结果本组60例手术切除患者,1年及3年生存率分别为65.40%和17.70%,根治性手术切除组和姑息性手术切除组的中位生存时间分别为20.7个月及14.2个月(P0.05)。单因素分析显示,手术方式、淋巴结转移情况、乙肝表面抗原阳性、神经侵犯、肿瘤数目和术前CA19-9水平对预后有影响(P0.05),多因素分析显示,手术方式、淋巴结转移情况、肿瘤数目和术前CA19-9水平为影响ICC预后的独立危险因素。结论肝内胆管细胞癌患者治疗以手术为主,根治性手术切除是获得长期生存的唯一途径。根治性切除、淋巴结转移情况、肿瘤数目及术前血清CA19-9水平是影响患者预后的独立危险因素。     

150例肝外胆管癌的临床病理与预后分析

目的：探讨肝外胆管癌的临床病理特点及预后分析。方法：选取2007年1月至2013年1月收治的150例肝外胆管癌患者,给予手术治疗,对患者术后的临床病理特点进行回顾性统计,选择Kaplan－Meier方法分析病理与预后的联系。结果：经过分析后得知,肝外胆管癌患者的1年生存率70．6％、2年生存率18．0％、3年生存率4．0％,平均生存时间18．5月。姑息性手术与根治性手术的生存率存在明显差异（ P＜0．05）。另外,肝管周围组织浸润阴性者预后效果明显优于阳性者（ P＜0．05）。肿瘤分化程度越好,患者预后效果越好。结论：针对肝外胆管癌患者,其术后预后因素主要包含肿瘤分化程度、肿瘤浸润和根治性手术,临床治疗时应考虑这些预后因素。     

肝门部胆管癌外科治疗及预后的相关因素分析

目的:探讨影响肝门部胆管癌预后的因素。方法:回顾性分析2005-02～2010-02我院肝胆外科诊治的122例肝门部胆管癌病人的临床资料,分析影响其预后的因素。结果:(1)全组病人3a生存率为29.5%,5a生存率为6.8%,中位生存期为13.2mo。不同手术方式病人术后3a生存率、5a生存率及中位生存期之间差异具有显著性(P<0.05)。单因素分析发现,肿瘤病理类型、分化程度、淋巴结及神经转移、切缘阳性是影响预后的因素。结果:显示,手术方式,病理类型、分化程度、淋巴转移及神经转移是影响预后的独立因素。结论:根治性切除术是治疗肝门部胆管癌的最佳手术方案,扩大淋巴结,受侵神经清扫是改善其远期存活率的重要措施。     

Long-term outcome and prognostic factors of intrahepatic cholangiocarcinoma

Background The management of intrahepatic cholangiocarcinoma （ICC） remains a challenge due to poor prognosis. The aim of this study was to summarize the surgical management experience in recent 10 years and to identify the influencing factors related to outcome of patients with ICC in a single hepatobiliary center. Methods From January 1995 to June 2005, 136 patients with ICC undergoing surgery were reviewed retrospectively. Survival rates of patients were calculated using the Kaplan-Meier method and compared by using the log-rank test. The prognostic factors were identified by the Cox regression model. Results Seventy-nine of 136 patients underwent resection, and 65 of 79 patients were curative （R0）. The surgical mortality was 2.2%. The 1-, 3- and 5-year survival rates of patients undergoing R0 resection were 72.1%, 35.6% and 20.1% respectively, which were significantly longer than those who underwent palliative resection and exploration, respectively （P 〈0.01）. At stage IV of the disease, 10 patients who underwent aggressive curative resection achieved a better median survival than those （n=12） without resection （14 months vs 3 months, P 〈0.001）. The independent prognostic factors of the whole group were TNM stage （OR, 2.013, P=0.008） and curative resection （OR, 2.957, P=0.003）. Higher TNM stage （OR, 1.894, P=0.004） and lymph node metastasis （OR, 4.248, P=0.005） linked to poor prognosis after R0 resection. For patients without lymph node metastasis, the median survival of those who underwent regional lymphadenectomy was comparable with those who did not （18 months vs 22 months, P=0.817）. Conclusions R0 resection is mandatory for ICC patient to achieve long-term survival. Aggressive resection benefits for selected patients with local advanced disease. Higher TNM stage and lymph node metastasis were poor prognostic factors for ICC patients after R0 resection.     

Clinicopathological features of female gastric carcinoma patients with curative resection: comparison with male patients

Little is known about the clinicopathological features of female gastric carcinoma (FGC) patients. We compared the clinicopathologic features and outcomes of FGC patients with curative resection with those of male gastric carcinoma (MGC) patients. We reviewed the hospital records of 940 FGC patients between 1986 and 2005 at Chonnam National University Hospital. Multivariate analysis showed that presence of serosal invasion, lymph node metastasis, and operative type were significant prognostic factors for survival of FGC patients with curative resection. Furthermore, the overall 5-year survival rate of FGC patients with curative resection (53.4%) was higher than that of MGC patients (47.6%, p<0.05). In advanced cases, no significant difference was observed in the overall 5-year survival rate between the FGC and MGC patients (41.6% vs 37.4%, p>0.05). Therefore, serosal invasion, lymph node metastasis, and type of operation were statistically significant parameters associated with survival. Early detection is more important for improving the prognosis of female patients with gastric cancer than for male patients.     

Intraoperative hyperthermic intraperitoneal chemotherapy as adjuvant chemotherapy for advanced gastric cancer patients with serosal invasion

BackgroundTo evaluate hyperthermic intraperitoneal chemotherapy (HIPEC) as an adjuvant chemotherapy in advanced gastric cancer (AGC) patients with serosal invasion.MethodsPatients who received radical surgery and palliative surgery between January 2002 and December 2010 were retrospectively examined. Patients were divided into two groups, namely, one group that underwent surgery and another group that underwent surgery with HIPEC. All patients who received HIPEC had suspected serosal invasion on an abdominal computed tomography or by the surgeon's assessment during the operation.ResultsThe prophylactic groups included 83 patients who underwent gastrectomy alone. A total of 29 patients underwent gastrectomy with HIPEC. The 5-year survival rates were 10.7% and 43.9%, respectively. The 5-year mean survival times were 22.66 (17.55–25.78) and 34.81 (24.97–44.66) months (p = 0.029), respectively. There were 52 patients who had a recurrence of carcinomatosis among 133 patients who had resections (52/133, 39.1%). The 3-year disease-free survival rate for carcinomatosis was 28.87% in the group that received surgery alone, whereas it was 66.03% in the group that received HIPEC. There was no significant difference in the rate of complication between the two groups in the prophylactic group (p = 0.542). Thus, curative surgery with HIPEC had a better prognosis for AGC with serosal invasion. The carcinomatosis recurrence time was longer in patients who underwent gastrectomy with HIPEC and received R0 resection.ConclusionThe survival benefit of HIPEC as an adjuvant therapy for gastric cancer patients with serosal invasion should be validated in a large cohort.     

影响肝内胆管癌切除术后患者生存率的危险因素分析及干预对策

目的分析影响肝内胆管癌（ICC）切除术后患者生存率的危险因素,并探讨相应的干预对策。方法回顾自2003年6月份以来人我院治疗的肝内胆管癌患者的资料,分析一般情况（性别、年龄）、个人行为（饮酒、吸炯）患者肝脏相关病史（乙肝、丙肝、肝硬化、胆石症、血吸虫病、肝囊肿以及脂肪性肝炎等与肝内胆管癌切除术后患者生存率的相关性,采用卡方检验、单因素非条件Logistic回归分析和多凼素非条件Logistic回归分析,模型筛选采用Stepwise法。评价影响肝内胆管癌切除术后患者生存率的危险因素。结果显示乙肝肝硬化（OR=1．769,95％CI：1．420—2．115）、酒精性肝硬化（OR=6．447,95％C1：1．826—22．769）、肝内胆管结石（OR=1．863,95％CI：1．709—2．051）、胆总管结石（OR：1．53995％CI：1．042—2．635）、HBsAg（OR=3．640,95％CI：2．169—6．193）等是肝内胆管癌切除术后患者死亡的主要促进因素。结论针对肝内胆管癌切除术后死亡的危险因素,我们提出了对肝内胆管癌患者应注意抗肝硬化、肝胆结石以及乙肝的治疗。     

Clinicopathological study of patients undergoing resection of hilar cholangiocarcinoma

Of the patients who underwent resection of hilar cholangiocarcinoma, those who received palliative surgery, or could not be followed up clinicopathologically, were excluded from this study. In the remaining 37 patients, the cumulative postoperative survival rate (simply referred to as the cumulative survival rate below) was analyzed according to gross types, histopathological parameters, final stages, and final curability. These patients showed a 5-year survival rate of 17.7% and a 50% survival of 2.2 years. By gross type, patients with a localized papillary or nodular expansion type tended to have a better survival rate than those with an invasive papillary or nodular expansion type. A greater histological depth of invasion tended to be associated with a poorer prognosis: the s(-) group, that is, a group of patients without serosal exposure of cancer (invasion depths of m, fm, and ss) had a significantly better prognosis than the s(+) group, a group of patients with serosal exposure of cancer (invasion depths of se and si). Other histopathological parameters, such as ly, pn, pHinf, pHM, and pEM, were associated with significant prognostic differences. By final stage, the stage I/II group and stage III or higher group showed a particularly significant difference in prognosis. By final curability, the curability A/B group had a significantly better prognosis than the curability C group. Taken together, surgery providing curability A and B promises a good long-term prognosis. Therefore, it is important that efforts are made to detect cancer early, adequately evaluate the degree of cancer extension, and determine the extent of resection and the surgical technique.     

不同时期胃癌的临床病理特点及预后比较分析

目的 对比1994至1999年与2000至2006年2个时期胃癌的临床病理特点及预后,探究影响胃癌预后的因素.方法 将1994年6月至2006年12月连续收治的1016例胃癌病例按手术治疗时间分为1994至1999年时期Ⅰ、2000至2006年时期Ⅱ两组,对比其临床病理特点变化,生存分析比较两组预后的不同,并分析影响预后的因素.结果 男女构成比、早期胃癌比例、临床不同TNM分期病例比例、专业化手术、辅助化疗方面,两组差异均有统计学意义(均P＜0.05).肿瘤部位、腹膜播散、淋巴结转移、根治切除率两组差异均无统计学意义(均P＞0.05).时期Ⅱ的5年总体生存率、根治切除后5年生存率分别为48.1%、61.5%,均显著高于时期Ⅰ的32.8%、42.4%(均P＜0.01).根治切除、淋巴结转移与否、进展期胃癌、临床不同TNM分期、无辅助化疗、专业化手术方面,时期Ⅱ的生存率都显著高于时期Ⅰ(均P＜0.01).多因素回归分析显示,Borrmann分型、病理组织类型、浸润深度、淋巴结转移、根治性手术、辅助化疗、不同时期是胃癌的独立预后因素.结论 时期Ⅱ胃癌的治疗效果得到很大提高,得益于早期胃癌诊断率的提高以及包括规范化的胃癌根治手术、辅助化疗的综合治疗.     

肝胆管结石并肝内胆管癌的诊治研究

目的对肝胆管结石并肝内胆管癌的诊疗方法进行分析和探讨。方法以2005年1月至2008年1月来我院治疗并通过手术和病理证实为肝胆管结石合并肝内胆管癌的47例患者的临床资料作为研究对象,47例患者均行开腹手术,其中根治性切除16例、姑息性切除15例、无法切除16例。结果根据随访调查,根治切除术患者术后半年、1年和2年的生存率分别为100%、93.75%、68.75%;姑息切除术为93.33%、40%、20%;无法切除术术后半年的生存率为31.25%,在之后的半年内患者全部死亡。结论肝胆管结石并肝内胆管癌缺乏特异性表现,因此在对肝内胆管结石症状反复出现的病人进行诊断时,应加强对实验室、影像学检查的应用,以免因漏诊而延误治疗的最佳时期。     

联合脏器切除治疗晚期胃癌

目的:探讨联合脏器切除治疗晚期胃癌的手术指征和疗效。方法:回顾性分析我院自2000年1月至2005年1月手术治疗的36例晚期胃癌患者的临床资料,对不同性质的手术治疗结果进行分析。结果:36例患者中行联合脏器切除23例,姑息性切除13例;联合脏器切除组1、2、3年的生存率分别为:86.9%、43.5%、26.1%;姑息性切除组1、2、3年生存率分别为:46.2%、30.8%、7.7%;两组间比较有显著性差异。结论:联合脏器切除用于晚期胃癌的根治性治疗是可行的,只要情况允许,应尽可能行联合脏器切除。