肝内胆管癌的病因学研究及预后分析

目的：探讨肝内胆管癌（intrahepatic cholangiocarcinoma,ICC）可能病因学以及预后相关因素的分析。方法：回顾性分析本院2000年1月至2007年12月手术治疗的46例肝内胆管癌的临床资料,根据不同治疗方法分为三组：根治性手术组、姑息手术组和保守治疗组,并对临床病理因素进行比对分析。结果：根治性手术组1、3和5年生存率分别为89.6%,49.8%,27.9%;姑息手术组1、3和5年生存率分别为47.5%,1.3%,0%;保守治疗组1、3和5年生存率分别为9.1%,0%,0%。三组之间的差异存在统计学差异（P〈0.05）。单因素分析患者肿瘤直径、组织学分化程度、肿瘤单发或多发、门静脉、淋巴结、腹膜转移、手术方式等影响肝内胆管癌预后的危险因素。多因素分析显示组织学分化程度、有无门静脉转移、淋巴结转移、腹膜转移及手术方式是影响预后的独立因素。结论：肝内胆管癌淋巴结转移率高,肝内复发是导致死亡的重要因素,根治性手术切除是最有效的治疗方法。组织学分化程度、门静脉转移、淋巴结转移、腹膜转移及手术方式是影响患者预后的独立危险因素。

The Etiology and Prognosis Analysis of Intrahepatic Cholangiocarcinoma

Objective： To explore possible etiology and prognostic factors of intrahepatic cholangiocarcinoma（ICC）.Method： The clinical data of 46 patients with ICC in our hospital from January 2002 to December 2007 were retrospectively analyzed,and all of them were successfully followed up.All patients were divided into three groups according to the treatment method,including the curative resection group,the palliative surgery and conservative treatment groups.Result： The overall 1-,3-,and 5-year survival rate of the 46 patients were 70.1%,41.6%,20.4%,respectively.The median survival time was 29 months.The 1-,3-,and 5-year survival rate for the curative resection group were 89.6%,49.8%,27.9%,respectively.These values were significantly higher than those of the palliative surgery and conservative treatment groups（P0.05）.Based on the univariate analysis,tumor size,histological grade,number of tumors,vascular invasion,serosal invasion,lymphatic invasion,and surgical treatment were significantly related to overall survival.Moreover,the Cox multivariant survival analysis revealed that histological grade,vascular invasion,serosal invasion,lymphatic invasion,and surgical treatment were independent prognostic indicators.Conclusion： The rate of the lymph node metastasis of ICC is high,and intrahepatic relapse is one of the main causes of death.Thus,radical resection is the most effective treatment for ICC.