肝门部胆管癌的危险因素分析

目的：探讨国内人群肝门部胆管癌（HC）发生的危险因素。方法：收集2011年8月至2012年7月本院治疗的肝门部胆管癌患者共128例为研究组,512例正常人为对照组,收集并统计分析与HC发生可能相关的危险因素,包括肝胆疾病及手术史,肝炎病史及其它因素如溃疡性结肠炎等。结果：研究组与对照组在胆总管结石（X2=21.759,P〈0.001）、肝内胆管结石（X2=20.645,P〈0.001）、胆囊结石（X2=69.532,P〈0.001）、胆囊切除术（X2=10.400,P=0.001）、胆道蛔虫病史（X2=11.231,P〈0.001）、肝血吸虫病史（X2=9.146,P=0.003）的发生率存在统计学差异,而其余各项不存在差异（P均〉0.05）。逐步logistic回归发现胆总管结石（OR=3.451,95%CI=0.889-11.327）、肝内胆管结石（OR=3.189,95%CI=0.783-10.482）、胆囊结石（OR=4.981,95%CI=1.645-21.482）、胆囊切除术（OR=2.783,95%CI=0.668-8.455）、胆道蛔虫病史（OR=3.589,95%CI=0.984-13.793）、肝血吸虫病史（OR=2.442,95%CI=0.401-6.742）是发生HC的高危因素。结论：我国人群中HC的危险因素主要包括了胆道结石及肝胆寄生虫病史,乙肝及丙肝不是其高危因素,通过了解HC的高危因素可以更深入了解HC的病因学内容,为临床诊治HC提供参考。

Analysis of Risk Factors in Hilar Cholangiocarcinoma

Objective： To investigate the risk factors of hilar cholangiocarcinoma（HC） in the domestic crowd.Method： From August 2011 to July 2012 in our hospital,a total of 128 cases of hilar cholangiocarcinoma were collected as the study group,512 cases of normal people as control group.The relevant risk factors were collected and statistically analyzed,including hepatobiliary disease and surgical history,history of hepatitis and other factors such as ulcerative colitis.Result： There was statistical difference in the incidence of common bile duct stones（X2 = 21.759,P 0.001）,intrahepatic bile duct stones（X2 = 20.645,P 0.001）,gallstone（X2 = 69.532,P 0.001）,cholecystectomy（X2 = 10.400,P =0.001）,the ascariasis history（X2 = 11.231,P 0.001）,hepatic schistosomiasis history（X2 = 9.146,P = 0.003） between the study group and control group,while the remaining did not differ from it（P 0.05）.Stepwise logistic regression found that the common bile duct stones（OR = 3.451,95% CI = 0.889-11.327）,hepatolithiasis（OR = 3.189,95%CI = 0.783-10.482）,gallbladder stones（OR = 4.981,95% CI = 1.645 to 21.482）,cholecystectomy（OR = 2.783,95%CI = 0.668-8.455）,history of biliary ascariasis（OR = 3.589,95% CI = 0.984-13.793）,hepatic schistosomiasis history（OR = 2.442,95% CI = 0.401-6.742） were risk factors to the occurrence of HC.Conclusion： Possible risk factors to HC in our population are biliary stones and the history of hepatobiliary parasites,but not including hepatitis B and hepatitis C.An in-depth understanding of the content of risk factors to HC provided a reference to understand the etiology,diagnosis and treatment of HC.