肝门部胆管癌49例临床治疗效果分析

Analysis on clinical therapeutic efficacy of 49 cases with hilar cholangiocarcinoma

目的：探讨影响肝门部胆管癌治疗效果的相关因素。方法：回顾分析49例肝门部胆管癌手术病例临床资料并进行统计分析。结果：49例患者中，实行根治性切除、姑息性手术及各种引流手术的患者平均术后生存时间分别为19．50月、8．79月及5．44月；而AJCC TNM分期Ⅰ期及Ⅱ期、Ⅲ期、Ⅳ期（Ⅳa期及Ⅳb期）患者平均术后生存时间分别为23．50月、9．37月及2．90月；术前日血清总胆红素水平〉300μmol／L组及≤300μmol／L组的患者平均术后生存时间分别为3．62月及14．74月；术后1周血清总胆红素水平〉40μmol／L组、20～40μmol／L组及〈20μmol／L组患者平均术后生存时间分别为5．68月、11．59月及22．17月。结论：肿瘤分期及手术根治程度是影响肝门部胆管癌疗效的主要影响因素，术前血清总胆红素水平及术后近期胆红素下降程度有望作为判断肿瘤远期疗效的指标之一。

Objective： To investigate the related factors for the therapeutic efficacy of hilar cholangiocarcinoma. Methods：A retrospective clinical analysis was performed on the clinical data from 49 patients with hilar cholangiocarcinoma. Results：The mean survival time was 19.5 months, 8.79 months, and 5.44 months for the total 49 patients who received radical resection, palliative resec- tion, and drainage operation, respectively. The mean survival time was 23.5 months, 9.37 months, and 2.90 months for patients at AJCC TNM stage Ⅰ and Ⅱ, Ⅲ, and Ⅳ （ Ⅳa and IVb）, respectively. The mean survival time was 3.62 months for patients with a total bilirubin level more than 300 μmol/L or 14.74 months for those patients with a total bilirubin level less than 300 μmol/L. The mean survival time was 5.68 months, 11.59 months, and 22.17 months for patients whose total serum bilirubin level was more than 40 μmol/ L, between 20 to 40 μmoL/L, and less than 20 μmoL/L one week after operation, respectively. Conclusion：TNM stage and curative resection degree are the main related factors influencing the therapeutic efficacy of hilar cholangiocarcinoma. The decreased degree in the serum level of total bilirubin before and after surgery has the potential to be used as a marker to predict the long-term therapeutic efficacy of hilar cholangiocarcinoma.