CAJ | 학술논문

目的探讨肝门部胆管癌的手术疗效及影响其预后的因素.方法回顾性分析中国医科大学附属第一医院1996年1月至2007年5月收治的204例肝门部胆管癌的临床资料,并进行多因素Cox回归模型预后因素分析.结果 204例按Bismuth-Corlette分型:Ⅰ型18例,Ⅱ型40例,Ⅲa型30例,Ⅲb型53例,Ⅳ型57例.其余6例未分型.术前行彩超、CT检查和MRCP检查与术中Bismuth分型对照,诊断符合率分别为53.7%、76.4%、100%.手术切除肿瘤92例,其中根治性切除(R0)55例,姑息性切除(R1、R2)37例.胆道探查置管引流98例,开腹探查6例,同种异体原位肝移植手术2例.手术切除组和非手术切除组生存率差异有统计学意义(x2=36.4,P<0.01),根治性切除组和姑息性切除组生存率差异有统计学意义(X2=22.9,P<0.05).Cox模型多因素分析表明手术方式、肿瘤细胞分化程度是二个独立的预后因素.结论肝门部胆管癌的治疗以手术切除为主,只有根治性切除才能达到最佳疗效.
목적 탐토간문부담관암적수술료효급영향기예후적인소.방법 회고성분석중국의과대학부속제일의원1996년1월지2007년5월수치적204례간문부담관암적림상자료,병진행다인소Cox회귀모형예후인소분석.결과 204례안Bismuth-Corlette분형:Ⅰ형18례,Ⅱ형40례,Ⅲa형30례,Ⅲb형53례,Ⅳ형57례.기여6례미분형.술전행채초、CT검사화MRCP검사여술중Bismuth분형대조,진단부합솔분별위53.7%、76.4%、100%.수술절제종류92례,기중근치성절제(R0)55례,고식성절제(R1、R2)37례.담도탐사치관인류98례,개복탐사6례,동충이체원위간이식수술2례.수술절제조화비수술절제조생존솔차이유통계학의의(x2=36.4,P<0.01),근치성절제조화고식성절제조생존솔차이유통계학의의(X2=22.9,P<0.05).Cox모형다인소분석표명수술방식、종류세포분화정도시이개독립적예후인소.결론 간문부담관암적치료이수술절제위주,지유근치성절제재능체도최가료효.
Objective To investigate the surgical effect of hilar cholangiocarcinoma and its impact on prognosis. Method The clinical data of 204 hilar cholangiocarcinoma admitted into the First Hospital of China Medical University were retrospectively analyzed. According to the Bismuth-corlette type, type Ⅰ was 18 cases, type Ⅱ 40 cases, type Ⅲ-a 30 cases, type Ⅲ-b 53 cases, type Ⅳ 57 cases. The other 6 cases was not typed. Color Doppler ultrasound, CT, MRCP were used to determine the Bismuth-Corlette type before the surgery. Based on preoperative image diagnosis the correct diagnosis rate was 53. 7%, 76. 4%, 100% for ultrasound, CT and MRCP respectively. Ninety-two cases underwent tumor resection, including radical resection (R0) in 55 cases, and palliative resection (R1, R2) in 37 cases. Ninety-eight cases underwent exploration and biliary drainage, 6 cases did laparotomy only, 2 cases received liver transplantation. The survival rate (P < 0. 001) is statistically different between patients receiving tumor resection and those not. Radical resection and palliative resection group are also statistically different in survival rates (P < 0. 05). Cox multivariate analysis shows that operation pattern, histological differentiation are two independent prognostic factors. Conclusion Surgery is the main method to treat hilar cholangiocarcinoma and radical resection could achieve the best effect. Reasonable perioperative treatment could reduce the complications and mortality.