67例肝门部胆管癌的外科治疗及预后分析

目的：探讨肝门部胆管癌（HCC）的外科治疗特点及预后因素,以期进一步提高HCC外科疗效。方法：回顾性分析67例病理诊断为HCC患者的临床资料。结果：不同手术方法术后累计生存率差异显著（P〈0.001）。根治切除组1、3年生存率显著高于姑息切除组和单纯引流组,手术切除组较非手术切除组生存时间显著提高（P〈0.001）。术前T分期和Bithmuth分型能指导手术切除率及术式选择。不同的T分期的手术切除率及切缘阴性率差异显著（P〈0.001）。分别对16个可能影响预后的因素进行单因素预后分析表明肿瘤大小、门静脉侵犯、局部浸润及转移、手术方法、UICC分期、改良T分期、淋巴结转移对预后有影响,统计学上有显著性差异（P〈0.05）。COX模型多因素预后分析表明手术方法、UICC分期是两个独立预后因素。结论：根治性切除是最重要预后因素,扩大手术范围能获得较好切缘无癌率,术前的T分期和Bismuth分型综合评估将有助于进一步在安全的范围内提高手术切除率及根治性切除率。

Surgical Management and Prognosis of 67 Cases with Cholangiocarcinoma of the Hepatic Hilum

Objecitve: To analyze surgical management and prognosis of hilar cholangiocarcinoma (HCC). Methods: Clinical data of 67 HCCs were retrospectively analyzed. Results: There was a significant difference in the cumulative survival rates among the groups treated with different surgical methods (P<0.001). The 1- and 3-year survival rates were significantly higher in the radical excision (RE) group than in the alleviated treatment (AT) and simple drainage (SD) groups, and there was an apparent improvement in the RE group compared to the non-resection groups (P<0.001). Preoperative evaluation of the T staging and Bismuth-Corlette typing could guide the decision for which surgical method would be best. There was a significant difference between the surgical removal rate and the negative incisal edge gin of various T stages (P<0.001,P=0.032). Results of the univariate analyses conducted for the 16 factors which may affect prognosis showed that tumor size, invasion of the portal vein, local infiltration and metastasis, surgical method, UICC staging and modified T stage, as well as lymphatic metastasis, were of prognostic value with statistical significance (P<0.05). Surgical management and the TNM staging were the two independent prognostic factors based on a multivariate analysis of the Cox Proportional Hazards Model. Conclusions: Radical excision is the most important prognostic factor for HCCs and an enlarged area of resection could improve the success rate of radical surgery. Preoperative evaluation of T staging and Bismuth-Corlette typing could also be helpful for improving the success rate.