门静脉栓塞术治疗III型及IV型肝门部胆管癌患者后肝再生情况的影响因素

目的：探讨门静脉栓塞（PVE）术治疗Bismuth-Corlett III型及IV型肝门部胆管癌患者后肝再生情况的影响因素。方法：收集2016年6月至2021年12月清华大学附属北京清华长庚医院肝胆胰中心72例通过PVE术治疗Bismuth-Corlett III型、IV型肝门部胆管癌患者的临床资料。按PVE术后第3周未来肝残余量再生率中位数进行分组，分为高再生组（38 例）和低再生组（34 例）。对两组患者肝再生的影响因素进行回归分析及生存时间序列分析。结果：PVE前预保留肝容积（FLR）为（447.97±99.93）mL，预保留肝容积率（FLRR）为33.83%，小于40%的临界值。PVE术后3 周患者FLR增长至（582.80±106.60）mL，FLRR中位数为44.32%。ΔFLR为（134.83±48.73）mL，FLR再生率中位数为27.6%。高再生组和低再生组间PVE前Bismuth-Corlett分型（P =0.027）、CA19-9水平（P =0.037）、区域淋巴结转移（P =0.019）及肝纤维化（P =0.014）的差异有统计学意义。多因素Logistic回归分析结果表明肝纤维化（P =0.034）是影响PVE后肝再生的主要危险因素。72 例肝门部胆管癌患者总体生存时间的中位数为12.2个月，95%CI =7.934～16.406。高再生组生存时间的中位数为18.0个月，低再生组生存时间的中位数为5.8个月，比较两组总体生存时间，差异有统计学意义（P =0.041）。结论：治疗Bismuth-Corlett III型、IV型肝门部胆管癌患者进行PVE术可以促进肝再生。高再生组较低再生组的生存时间的中位数延长。肝再生的影响因素有胆管癌分型、淋巴结转移、CA19-9、纤维化，其中肝纤维化是影响肝再生的主要危险因素。

Influencing factors of liver regeneration after portal vein embolization in patients with type III and IV hilar cholangiocarcinoma

Objective: To investigate the influencing factors of liver regeneration after portal vein embolization for Bismuth-Corlett type III and type IV hilar cholangiocarcinoma. Methods: Clinical data of 72 patients with Bismuth-Corlett type III and Type IV hilar cholangiocarcinoma treated by PVE were collected from June 2016 to December 2021 in Hepatobiliary and Pancreatic Center of Affiliated Tsinghua Chang-geng Hospital of Tsinghua University. The patients were divided into the high regeneration group (38 cases) and the low regeneration group (34 cases) according to the median future residual liver regeneration rate at the third week after PVE surgery. The liver regeneration, influencing factors and survival time of the two groups were retrospectively analyzed. Results: The FLR before PVE was (447.97±99.93)mL, and the median FLRR was 33.83%, less than the critical value of 40%. Three weeks after PVE, FLR increased to (582.80±106.60)mL and the median FLRR was 44.32%. The FLR was (134.83±48.73)mL, with a median FLR regeneration rate of 27.6%. Bismuth-Corlett type before PVE (P=0.027), CA19-9 level (P=0.037), regional lymph node metastasis (P=0.019) and liver fibrosis (P=0.014) were significantly different between the high and low regeneration groups.There was no significant difference in other indicators between the two groups. Logistic multivariate regression analysis showed that liver fibrosis (P=0.034) was a major risk factor for liver regeneration after PVE. There were 72 patients with hilar cholangiocarcinoma, with an overall median survival time of 12.2 months, with95%CI=7.934-16.406. The median survival time of the high regeneration group and the low regeneration group was 18.0 months and of 5.8 months respectively, showing statistical difference (P=0.041). Conclusion: PVE can promote liver regeneration in patients with Bismuth-Corlett type III and type IV hilar cholangiocarcinoma. The median survival time of high regeneration group was longer than that of low regeneration group. The influencing factors of liver regeneration include cholangiocarcinoma type, lymph node metastasis, CA19-9 and fibrosis. Liver fibrosis is a major risk factor affecting liver regeneration.