CAJ | 학술논문

目的：本研究的目的旨在探讨原发性肝癌合并胆管癌栓手术和再手术治疗的疗效及预后。方法回顾性分析从1998年1月至2008年8月在本院行根治性切除的880例原发性肝癌患者的临床资料，其中28例患者合并有胆管癌栓。评估原发性肝癌合并胆管癌栓的患者手术和再手术治疗的疗效及预后。并对相关影响因素进行分析。结果原发性肝癌合并胆管癌栓的28例患者的1、3、5年生存率分别为89.3%、46.4%、21.4%，而不伴有胆管癌栓的852例患者的1、3、5年生存率分别为91.4%、52.9%、20.9%，差异无统计学意义（P＞0.05）。原发性肝癌合并胆管癌栓的患者中有6例患者在肿瘤复发后再次行手术治疗，其生存时间超过那些复发后没有行再次手术的患者，差异有统计学意义（P＜0.05）。单因素分析显示肿瘤的大小、数量、分化水平、生长方式及门静脉侵犯与第一次手术后的无瘤生存期和总生存期有显著性相关（P＜0.05）。多因素分析表明门静脉侵犯和肿瘤大小是影响无瘤生存期与总生存期的独立危险因素（P＜0.05）。单因素与多因素分析显示梗阻性黄疸与无瘤生存期和总生存期无显著性相关（P＞0.05）结论根治性切除联合胆管癌栓取出是治疗原发性肝癌合并胆管癌栓的有效治疗方法。梗阻性黄疸不是外科手术治疗的禁忌证。肿瘤复发后适时选择再次手术能够取得更好的效果。
목적：본연구적목적지재탐토원발성간암합병담관암전수술화재수술치료적료효급예후。방법회고성분석종1998년1월지2008년8월재본원행근치성절제적880례원발성간암환자적림상자료，기중28례환자합병유담관암전。평고원발성간암합병담관암전적환자수술화재수술치료적료효급예후。병대상관영향인소진행분석。결과원발성간암합병담관암전적28례환자적1、3、5년생존솔분별위89.3%、46.4%、21.4%，이불반유담관암전적852례환자적1、3、5년생존솔분별위91.4%、52.9%、20.9%，차이무통계학의의（P＞0.05）。원발성간암합병담관암전적환자중유6례환자재종류복발후재차행수술치료，기생존시간초과나사복발후몰유행재차수술적환자，차이유통계학의의（P＜0.05）。단인소분석현시종류적대소、수량、분화수평、생장방식급문정맥침범여제일차수술후적무류생존기화총생존기유현저성상관（P＜0.05）。다인소분석표명문정맥침범화종류대소시영향무류생존기여총생존기적독립위험인소（P＜0.05）。단인소여다인소분석현시경조성황달여무류생존기화총생존기무현저성상관（P＞0.05）결론근치성절제연합담관암전취출시치료원발성간암합병담관암전적유효치료방법。경조성황달불시외과수술치료적금기증。종류복발후괄시선택재차수술능구취득경호적효과。
Objective Few reports have evaluated the efficacy of re-operation for relapse after initial surgery for hepatocellular carcinoma(HCC) with bile duct thrombosis(BDT).The aim of this study was to investigate the efficacy of initial surgery and subsequent re-operation for hepatocellular carcinoma (HCC) with bile duct thrombosis(BDT),and their effects on prognosis. Methods The clinical data of 880 patients with HCC,including 28 patients with BDT,who underwent radical hepatectomy between 1998 and 2008 in our hospital,were reviewed.The effects of BDT and re-operation on prognosis were retrospectively analyzed. Results The 1-,3-and 5-year survival rates were 89.3%,46.4%and 21.4%, respectively, in 28 patients with BDT versus 91.4%, 52.9%and 20.9%in 852 patients without BDT (P>0.05).Six patients with BDT underwent re-operation after disease relapse,and their survival time was significantly longer than those who did not undergo re-operation (P<0.05). Univariate analysis showed that the tumor-free survival time and total survival time after the first session of surgery were significantly correlated with tumor size,number,differentiation level,growth pattern and invasion to portal vein (P<0.05).Multivariate analysis revealed that invasion to the portal vein and tumor size were independent factors that influenced the tumor-free survival time and total survival time (P < 0.05). Univariate analysis and multivariate analyses showed that obstructive jaundice was not significantly associated with tumor-free survival time or total survival time (P>0.05). Conclusions Hepatectomy plus BDT removal is an effective treatment option for HCC with BDT.Obstructive jaundice is not a contraindication for surgery.Re-operation after relapse can provide good outcomes if the cases are appropriately selected.