CAJ | 학술논문

目的探讨影响肝门部胆管癌的预后因素.方法回顾性分析1996年1月至2007年5月中国医科大学附属第一医院收治的204例肝门门部胆管癌患者的临床资料.生存时间用中位数表示,生存分析采用Kaplan-Meier法,行Log-rank检验,对17个可能影响预后的因素进行单因素分析,有统计学意义的单因素再采用Cox回归模型进行多因素分析.结果根治性切除中位生存时间为37个月,姑息性切除为18个月,胆道探查置管引流为11个月,剖腹探查为5个月,肝移植为25个月,五者比较差异有统计学意义(χ2=58.300,P<0.05).肿瘤最长径、门静脉或肝动脉侵犯、局部浸润、残端情况、肿瘤分化程度、淋巴结转移、手术方式对预后有影响(χ2=6.541,8.159,5.837,4.365,13.748,5.346,9.472,P<0.05).Cox回归模型多因素分析表明手术方式、肿瘤细胞分化程度是影响预后的独立因素(b=0.287,0.320,P<0.05).结论根治性切除是肝门部胆管癌最重要的预后因素,合理的围手术期处理能提高患者的生存率.
목적 탐토영향간문부담관암적예후인소.방법 회고성분석1996년1월지2007년5월중국의과대학부속제일의원수치적204례간문문부담관암환자적림상자료.생존시간용중위수표시,생존분석채용Kaplan-Meier법,행Log-rank검험,대17개가능영향예후적인소진행단인소분석,유통계학의의적단인소재채용Cox회귀모형진행다인소분석.결과 근치성절제중위생존시간위37개월,고식성절제위18개월,담도탐사치관인류위11개월,부복탐사위5개월,간이식위25개월,오자비교차이유통계학의의(χ2=58.300,P<0.05).종류최장경、문정맥혹간동맥침범、국부침윤、잔단정황、종류분화정도、림파결전이、수술방식대예후유영향(χ2=6.541,8.159,5.837,4.365,13.748,5.346,9.472,P<0.05).Cox회귀모형다인소분석표명수술방식、종류세포분화정도시영향예후적독립인소(b=0.287,0.320,P<0.05).결론 근치성절제시간문부담관암최중요적예후인소,합리적위수술기처리능제고환자적생존솔.
Objective To investigate the prognostic factors of hilar cholangiocarcinoma. Methods The clinical data of 204 patients with hilar cholangiocarcinoma who were admitted to The First Affiliated Hospital of China Medical University from January 1996 to May 2007 were retrospectively analyzed. The survival rate was calculated using the Kaplan-Meier method and Log-rank test. Seventeen factors that may have influenced prognosis were analyzed by univariate analysis. Factors that were statistically significant were further analyzed by the Cox regression model. Results The median survival times of patients who received radical resection, palliative resec-tion, bile duct exploration and catheter drainage, exploratory laparotomy, and liver transplantation were 37, 18, 11,5 and 25 months, respectively, and there was a significant difference between the 5 groups (χ2 = 58. 300, P < 0. 05). The prognostic factors included tumor size, portal vein or hepatic artery invasion, local invasion, resection margin, tumor grading, lymph node metastasis and surgical procedure (χ2 =6. 541, 8. 159, 5. 837, 4. 365, 13.748, 5.346, 9.472, P <0.05). Multivariate analysis demonstrated that surgical procedure and tumor grading were independent prognostic factors (6=0.287, 0. 320, P <0.05). Conclusions Radical resection is the most important prognostic factor of hilar cholangiocarcinoma. Appropriate perioperative care can improve the survival rate.