医学信息
醫學信息
의학신식
MEDICAL INFORMATION
2014年
2期
59-60
,共2页
胆管癌%临床分型%根治性切除%存活率%并发症
膽管癌%臨床分型%根治性切除%存活率%併髮癥
담관암%림상분형%근치성절제%존활솔%병발증
Cholangiocarcinoma%Clinical type%Radical resection%Survival rate%Complications
目的：通过对肝门部胆管癌的临床分型、手术治疗及疗效分析,探讨影响肝门部胆管癌手术疗效及预后的相关因素。方法对2003年1月~2008年1月298例肝门部胆管癌进行回顾分析,对其临床分型、手术方式及疗效进行分析。结果298例患者中，行手术切除149例，根治性切除(肿瘤完全切除和隐性切缘 R0)74例(占49.6%)，姑息性切除(切缘镜下可见癌细胞R1、切缘肉眼可见癌细胞R2)75例(占50.3%)。姑息引流术124例，未手术25例。术后1、2、3年存活率：R0切除组分别为68.3%、35.6%和27.2%；R1、R2切除组分别为45.2%、16.7%和12.5%；引流组分别为22.7%、1.8%和0,未手术组分别为8.3%、0和0，根治性切除组和姑息性切除组存活率差异有统计学意义(P<0.05)。2例围手术期死亡(1.3%)，105例出现手术并发症(38.5%)；本组病例行MRI、MRCP检查206例，均全部不同程度发现肿瘤，阳性率100%。结论肝门部胆管癌分型及手术方式与预后明显相关；肝门部胆管癌的治疗仍以手术治疗为主,只有根治性切除才能获得最佳疗效，延长患者存活期。对有可疑征像者行MRI及MRCP检查，可显著提高诊断符合率；加强围手术期综合治疗，可以降低患者术后并发症。
目的：通過對肝門部膽管癌的臨床分型、手術治療及療效分析,探討影響肝門部膽管癌手術療效及預後的相關因素。方法對2003年1月~2008年1月298例肝門部膽管癌進行迴顧分析,對其臨床分型、手術方式及療效進行分析。結果298例患者中，行手術切除149例，根治性切除(腫瘤完全切除和隱性切緣 R0)74例(佔49.6%)，姑息性切除(切緣鏡下可見癌細胞R1、切緣肉眼可見癌細胞R2)75例(佔50.3%)。姑息引流術124例，未手術25例。術後1、2、3年存活率：R0切除組分彆為68.3%、35.6%和27.2%；R1、R2切除組分彆為45.2%、16.7%和12.5%；引流組分彆為22.7%、1.8%和0,未手術組分彆為8.3%、0和0，根治性切除組和姑息性切除組存活率差異有統計學意義(P<0.05)。2例圍手術期死亡(1.3%)，105例齣現手術併髮癥(38.5%)；本組病例行MRI、MRCP檢查206例，均全部不同程度髮現腫瘤，暘性率100%。結論肝門部膽管癌分型及手術方式與預後明顯相關；肝門部膽管癌的治療仍以手術治療為主,隻有根治性切除纔能穫得最佳療效，延長患者存活期。對有可疑徵像者行MRI及MRCP檢查，可顯著提高診斷符閤率；加彊圍手術期綜閤治療，可以降低患者術後併髮癥。
목적：통과대간문부담관암적림상분형、수술치료급료효분석,탐토영향간문부담관암수술료효급예후적상관인소。방법대2003년1월~2008년1월298례간문부담관암진행회고분석,대기림상분형、수술방식급료효진행분석。결과298례환자중，행수술절제149례，근치성절제(종류완전절제화은성절연 R0)74례(점49.6%)，고식성절제(절연경하가견암세포R1、절연육안가견암세포R2)75례(점50.3%)。고식인류술124례，미수술25례。술후1、2、3년존활솔：R0절제조분별위68.3%、35.6%화27.2%；R1、R2절제조분별위45.2%、16.7%화12.5%；인류조분별위22.7%、1.8%화0,미수술조분별위8.3%、0화0，근치성절제조화고식성절제조존활솔차이유통계학의의(P<0.05)。2례위수술기사망(1.3%)，105례출현수술병발증(38.5%)；본조병례행MRI、MRCP검사206례，균전부불동정도발현종류，양성솔100%。결론간문부담관암분형급수술방식여예후명현상관；간문부담관암적치료잉이수술치료위주,지유근치성절제재능획득최가료효，연장환자존활기。대유가의정상자행MRI급MRCP검사，가현저제고진단부합솔；가강위수술기종합치료，가이강저환자술후병발증。
Objective To explore the impact and prognostic factors of surgical treatmen of hilar cholangiocarcinoma by analyzing clinical classification , surgical treatment and outcome. Methods 298 cases of hilar cholangiocarcinoma were retrospectively analyzed from January 2003 to January 2008,the clinical classification, surgical procedures and treatment were analyzed. Results 298 cases of patients, 149 cases of surgical resection , radical resection ( complete tumor resection and implicit margin R0) 74 cases ( 49.6%) , pal iative resection ( cut ing edge microscope, cancer cells R1, gross margin visible cancer R2) 75 cases ( 50.3% ). Pal iative drainage in 124 cases,25 cases without surgery .3-year survival rate after surgery:R0 resection group were 68.3%, 35.6%and 27.2%. R1 and R2 resection group were 45.2 %, 16.7%and 12.5%.Drainage group were 22.7%, 1.8%and 0, not surgery group were 8.3%, 0 and 0 , radical resection group and pal iative resection group survival dif erence was statistical y significant (P<0.05). Two cases of perioperative death (1.3%),105 cases of surgical complications occurred (38.5%); 206 cases underwent MRI, MRCP examination , tumors were found in al the dif erent levels , the positive rate of 100%. Conclusion Hilar cholangiocarcinoma classification and surgical treatment significantly associate with prognosis. only radical resection hilar cholangiocarcinoma can receive best outcome and prolong life.For suspicious signs like those of MRI and MRCP examination,can significantly improve the diagnosis rate ,perioperative comprehensive treatment can reduce postoperative complications.
