不同临床和病理分型对肝门部胆管癌切除术预后的影响

Effect of the differences in clinical and pathological classification of hilar cholangiocarcinoma on the prognosis after resection

目的研究临床和病理分型与肝门部胆管癌切除术疗效的关系。方法总结1993年至2004年在解放军总医院肝胆外科手术切除的肝门部胆管癌198例病例资料。结果临床分型Ⅰ型34例,Ⅱ型60例,Ⅲa型27例,Ⅲb型33例,Ⅳ型19例,Ⅴa型6例,Ⅴb型19例。病理高分化腺癌35例,中分化腺癌52例,低分化腺癌54例,三者的中位生存期分别为29.5、11、5.5个月;病理切缘阴性者与切缘阳性者生存率有显著性差异(P<0.05)。手术并发症出现率41.4%,围手术期死亡1例。结论肝门部胆管癌根据临床分型进行相应的手术治疗;病理切缘阴性是影响预后的主要因素之一;围手术期正确处理,是减少手术并发症,提高患者生活质量和延长生存期的关键。

Objective To investigate the relationship between the prognosis of curative resection of hilar cholangiocarinoma and clinical pathologic classification. Methods A retrospective analysis was performed in 198 patients of hilar cholangiocarcinoma from 1993 to 2004. Results 34 cases were in class Ⅰ , 60 in class Ⅱ, 27 in class Ⅲa, 33 in class Ⅲb, 19 in class Ⅳ, 6 in class Ⅴa, 19 in class Ⅴb. The mean survival of well-, moderately-, poorly-differentiated adenocarcinoma was 29.5, 11 and 5.5 months respectively. There was a remarkable difference in survival between patients with negative resection margins and those with positive ones. Conclusions The main treatment of hilar cholangiocarinoma is curative resection according to clinical classification. Negative resection margin plays an important role in curative effect and long term survival in patients with HCC. Appropriate perioperative management can reduce the operative morbidity and mortality.