中下段胆管癌切除术后切缘阳性的意义分析

目的：探讨中下段胆管癌切除术后切缘阳性的意义。方法：回顾性分析在本院住院治疗的中下段胆管癌患者70例，以术后是否复发分组进行影响患者术后复发的各项因素单因素和多因素分析；对不同切缘患者的生存时间进行分析。结果：术后随访有28例患者复发，复发率为40%。单因素分析结果显示：术前引流的患者复发率（47.27%）高于未做术前引流的患者（13.33%），有浸润的患者复发率（62.07%）高于无浸润的患者（24.39%），病理高分化的患者复发率（55.56%）高于非高分化的患者（13.33%），切缘 R1的患者复发率（83.33%）高于切缘 R0的患者（31.03%），淋巴结转移的患者复发率（72.22%）高于无淋巴结转移的患者（25.85%）；多因素分析结果显示：术前引流、浸润型、切缘 R1、淋巴结转移是胆管癌术后复发的主要危险因素。切缘为 R0的患者5年随访期中位复发时间22个月显著的高于切缘为 R1的患者的15个月。切缘为 R0的患者5年随访期中位生存时间36个月显著的高于切缘为 R1的患者的33个月。结论：术前引流、浸润型、切缘 R1、淋巴结转移是中下段胆管癌切除术后复发的危险因素，切缘为 R0的患者的生存时间高于切缘为 R1的患者。

Significance of positive resection margin of in the middle and distal part of bile duct carcinoma after surgical resection

Objective To explore the significance of positive resection margin of the middle and distal part of bile duct carcinoma after resection. Methods Retrospective analysis of 70 cases of bile duct cancer patients in our hospital, single fac-tor and multi factor analyze the factors that affect the recurrence after operation; The survival time of patients with different cutting edge was analyzed. Results There were 28 cases of recurrence after the operation and the recurrence rate was 40%. Single factor analysis showed that: The recurrence rate of preoperative drainage patients(47.27%)was higher than that non-preoperative drainage patients(13.33%), the patients with infiltration(62.07%)was higher than without infiltration(24.39%), the well-differentiated patients(55.56%)was higher than not well-differentiated patients(13.33%), the patients with R0 resection margin(83.33%)was higher than R1(31.03%), the patients of lymph node metastasis(72.22%)was higher than that in patients without lymph node metastasis(25.85%); Multivariate factor analysis showed that: Preoperative drainage, infiltrating type, re-section margin R1, lymph node metastasis were the main risk factors for postoperative recurrence of bile duct carcinoma. The median recurrence time of resection margin R0 patients was 22 months after 5 years of follow-up significantly higher than R1 patients was 15 months. The median survival time of resection margin R0 patients was 36 months after 5 years of follow-up significantly higher than R1 patients was 33 months. Conclusion Preoperative drainage, infiltrating type, resection margin R1, lymph node metastasis were the main risk factors for postoperative recurrence of bile duct carcinoma, the survival time of pa-tients with R0 resection margin was higher than that of patients with R1.