CAJ | 학술논문

目的:探讨影响肝门部胆管癌手术预后的因素.方法:对经手术切除的74例肝门部胆管癌病例资料进行回顾性分析,以kaplan-meier法计算生存率和生存期,对性别、年龄、肿瘤分化情况、肿瘤分型、联合肝脏切除、镜下切缘、淋巴结转移情况分别进行Log-rank检验、Cox回归分析,分析各因素与预后生存期的关系.结果:(1)74例肝门部胆管癌术后患者的1年、3年、5年生存率分别是33.5%、16.4%、3.0%,中位生存期为(11±4.0)个月;其中病理切缘阴性病例的1年、3年、5年的生存率分别是46.4%、28.3%、5.0%,中位生存期为(20±3.4)个月.(2)单因素分析显示与肝门部胆管癌手术预后显著相关的因素是肿瘤分化程度、肿瘤Bismuth分型、联合肝脏切除、镜下切缘程度和淋巴结转移情况.(3)多因素分析显示肿瘤Bismuth分型、联合肝脏切除、镜下切缘程度与肝门部胆管癌患者手术预后显著相关.结论:在肝门部胆管癌的手术治疗中,应彻底将肝十二指肠韧带骨骼化、清扫区域淋巴结,重视获得病理阴性切缘.对于BismuthⅠ型和Ⅱ型患者,扩大联合肝切除的指征可能改善预后.
목적:탐토영향간문부담관암수술예후적인소.방법:대경수술절제적74례간문부담관암병례자료진행회고성분석,이kaplan-meier법계산생존솔화생존기,대성별、년령、종류분화정황、종류분형、연합간장절제、경하절연、림파결전이정황분별진행Log-rank검험、Cox회귀분석,분석각인소여예후생존기적관계.결과:(1)74례간문부담관암술후환자적1년、3년、5년생존솔분별시33.5%、16.4%、3.0%,중위생존기위(11±4.0)개월;기중병리절연음성병례적1년、3년、5년적생존솔분별시46.4%、28.3%、5.0%,중위생존기위(20±3.4)개월.(2)단인소분석현시여간문부담관암수술예후현저상관적인소시종류분화정도、종류Bismuth분형、연합간장절제、경하절연정도화림파결전이정황.(3)다인소분석현시종류Bismuth분형、연합간장절제、경하절연정도여간문부담관암환자수술예후현저상관.결론:재간문부담관암적수술치료중,응철저장간십이지장인대골격화、청소구역림파결,중시획득병리음성절연.대우BismuthⅠ형화Ⅱ형환자,확대연합간절제적지정가능개선예후.
Objective To investigate the risk factors on prognosis of resected hilar cholangiocarcinoma, in order to improve the effect of surgical treatment. Methods Seventu-four cases of hilar cholangiocarcinoma treated by surgery were reviewed retrospectively. The Kaplan-Meier analysis was used to calculate survival rates and survival time. The Log-rank analysis and COX regression analysis were used to analyze the relationship be-tween prognosis and the factors including gender, age, tumor differentiation,tumor type, liver resection, surgical margin,and lymph node metastasis. Results The overall 1-,3-and 5-year survival rates were 33.5%,16.4%, 3.0% respectively. The overall median survival time was (11±4.0) months. For negative surgical margin group,the 1-,3-and 5-year survival rates were 46.4%, 28.3%, 5.0% respectively. And the median survival time was(20± 3.4)months. Tumor differentiation,tumor type, liver resection, surgical margin, and nodular metastasis showed sta-tistic relationship with prognosis in the univariate analysis. The further multivariate showed statistic relationship among tumor type, liver resection,surgical margin and prognosis. Conclusion In surgical approach to hilar BismuthⅠandⅡ, combination of liver resection may achieve a better prognosis.