CAJ | 학술논문

目的：探讨经皮经肝胆汁引流（PTCD）术后不同抗肿瘤治疗方式对胆管癌致恶性梗阻性黄疸患者生存期影响。方法收集2012年1月至2013年3月治疗的60例经胆道钳夹活检明确诊断为胆总管中、下段腺癌，按照TNM肿瘤分期分为Ⅱ期9例，Ⅲ期39例、Ⅳ期12例。按照分化程度区分高分化者9例、中分化者37例、低分化者14例。将此60例患者纳入研究中，所有患者行引流管置入及支架植入以解除黄疸症状，根据后续抗肿瘤治疗方式不同将患者分为3组，A组引流手术后行规律动脉灌注化疗；B组引流手术后行胆道内粒子链植入；C组引流手术后行规律动脉灌注化疗及胆道内粒子链植入。应用SPSS17.0统计软件进行统计学分析。肿瘤患者的死亡因素分析采用多变量Cox比例风险回归分析，以P＜0.05为差异有统计学意义。结果 A组中位生存期为（186.0±36.4）d，B组中位生存期为（183.0±26.5）d， C组中位生存期为（252.0±43.6）d。肿瘤患者的死亡因素分析采用多变量Cox比例风险回归分析，患者生存期影响因素经多变量Cox比例风险回归分析显示，肿瘤分期[HR=8.434，95%CI（3.41~20.090）]是死亡的危险因素，治疗方式[HR=0.616，95%CI（0.429~0.884）]是死亡的保护因素，肿瘤分化程度（Score检验，字2=0.197，P=0.657）与死亡无关。与A组相比，B组患者的死亡风险无明显差异[HR=1.012，95%CI（0.558~2.179）]，而C组治疗方式[HR=0.334，95%CI（0.148~0.075）]是死亡的保护因素。结论肿瘤TNM分期及不同治疗方式对中下段胆总管癌患者生存时间有影响，中下段胆总管癌致梗阻性黄疸患者引流术后应行化疗及内放疗相结合的综合介入治疗，确能延长患者生存期。
목적：탐토경피경간담즙인류（PTCD）술후불동항종류치료방식대담관암치악성경조성황달환자생존기영향。방법수집2012년1월지2013년3월치료적60례경담도겸협활검명학진단위담총관중、하단선암，안조TNM종류분기분위Ⅱ기9례，Ⅲ기39례、Ⅳ기12례。안조분화정도구분고분화자9례、중분화자37례、저분화자14례。장차60례환자납입연구중，소유환자행인류관치입급지가식입이해제황달증상，근거후속항종류치료방식불동장환자분위3조，A조인류수술후행규율동맥관주화료；B조인류수술후행담도내입자련식입；C조인류수술후행규율동맥관주화료급담도내입자련식입。응용SPSS17.0통계연건진행통계학분석。종류환자적사망인소분석채용다변량Cox비례풍험회귀분석，이P＜0.05위차이유통계학의의。결과 A조중위생존기위（186.0±36.4）d，B조중위생존기위（183.0±26.5）d， C조중위생존기위（252.0±43.6）d。종류환자적사망인소분석채용다변량Cox비례풍험회귀분석，환자생존기영향인소경다변량Cox비례풍험회귀분석현시，종류분기[HR=8.434，95%CI（3.41~20.090）]시사망적위험인소，치료방식[HR=0.616，95%CI（0.429~0.884）]시사망적보호인소，종류분화정도（Score검험，자2=0.197，P=0.657）여사망무관。여A조상비，B조환자적사망풍험무명현차이[HR=1.012，95%CI（0.558~2.179）]，이C조치료방식[HR=0.334，95%CI（0.148~0.075）]시사망적보호인소。결론종류TNM분기급불동치료방식대중하단담총관암환자생존시간유영향，중하단담총관암치경조성황달환자인류술후응행화료급내방료상결합적종합개입치료，학능연장환자생존기。
Objective To discuss the influence of different antitumor treatments on the survival time of patients with obstructive jaundice caused by cholangiocarcinoma located at middle-low segment of common bile duct after receiving PTCD. Methods During the period from Jan. 2012 to March 2013, a total of 60 patients with pathologically-proved cholangiocarcinoma located at the middle-low segment of common bile duct were admitted to authors’ hospital. According to tumor TNM staging, stage Ⅱ was seen in 9 cases, stage Ⅲ in 39 cases and stage Ⅳ in 12 cases. Based on the degree of cell differentiation, highly differentiated cancer was observed in 9 cases, moderately differentiated cancer in 37 cases, and poorly differentiated cancer in 14 cases. The 60 patients were enrolled in this study. Drainage tube placement and stent implantation were performed in all patients so as to relieve the symptoms of jaundice. According to the antitumor treatment used, the 60 patients were randomly and equally divided into three groups with 20 patients in each group. Draining procedure with subsequent regular arterial infusion chemotherapy was employed in the patients of group A; draining procedure with subsequent particle chain placement in biliary tract was performed in the patients of group B; and draining procedure with subsequent regular arterial infusion chemotherapy together with particle chain placement in biliary tract was carried out in the patients of group C. The results were analyzed using SPSS17.0 statistical software. The death factors of patients were statistically evaluated by using multivariate Cox proportional hazards regression analysis method, P<0.05 was considered that the difference had statistical significance. Results The median survival periods of group A, B and C were (186.0±36.4) days, (183.0±26.5) days and (252.0±43.6) days respectively. The death factors of cancer patients were analyzed by using multivariate Cox proportional hazards regression analysis method, which indicated that tumor stage was a risk factor for death (HR=8.434, 95%CI 3.41-20.090);the treatment mode was a protection factor of death (HR=0.616, 95%CI 0.429-0.884); while the degree of tumor differentiation was unrelated to death(score test,字2=0.197, P=0.657>0.05). The risk of death in group B was not significantly different from that in group A (HR=1.012, 95%CI 0.558-2.179); while the treatment mode of group C was a protection factor of death (HR=0.334, 95%CI 0.148-0.075). Conclusion The TNM stage and treatment mode can influence the survival time of patients with cholangiocarcinoma located at the middle-low segment of common bile duct. Therefore, for the treatment of obstructive jaundice caused by cholangiocarcinoma, combination use of regular arterial infusion chemotherapy and particle chain placement in biliary tract should be employed immediately after draining procedure as this therapeutic mode can effectively prolong patient’s survival time.