影响手术治疗肝门胆管癌预后的多因素分析

Predictive factors on operative therapy of the hilar cholangiocarcinoma

背景与目的:肝门胆管癌的预后较差,究竟哪些因素影响其预后,目前可借鉴的资料不多。本研究旨在探讨影响手术治疗肝门胆管癌预后的因素。方法:回顾我院2000年1月—2003年12月间手术治疗的33例肝门胆管癌患者的临床资料,对其中的22例获得有效临床随访的患者,采用Kaplan-Meier法计算生存率,并采用多因素分析方法探讨患者年龄、血生化指标、淋巴结转移、手术时间、术中出血量、术后并发症等因素与预后的关系。结果:所有33例患者的肝门胆管癌均得到手术切除,手术切除率100%,围手术期死亡率3.0%。有完整临床随访资料患者22例,最长随访54个月,1年生存率为92.3%,2年生存率为73.8%,3年生存率为36.9%,中位生存时间为20个月;多因素分析显示,年龄(P=0.004)、血清总胆红素(P=0.012)、手术时间(P=0.021)、术中出血量(P=0.004)是影响术后患者预后的独立因素。结论:年龄、血清总胆红素、手术时间、术中出血量是影响手术治疗肝门胆管癌患者预后的独立因素。

Background and purpose： The prognosis of hilar cholangioearcinoma is poor. This research was to investigate the prognostic factors among the age of patients, blood biochemical indicator, metastasis of lymph node, operative duration, volume of blood loss during operation, and complication on hilar cholangiocarcinoma. Methods： All the 22 out of 33 patients with hilar cholangioearcinoma were analyzed from January, 2000 to December, 2003 in our hospital. Kaplan- Meier analysis was used to calculate survival, a multi-parameter analysis was used to explore the relationship among the prognosis and the above clinical factors. Results： All the 33 hilar eholangioearcinoma were resected, the resection rate was 100%, perioperative mortality was 3.0% （ 1/33）. 22 out of the 33 patients were followed up and the survival at one year was 92.3%, two years was 73.8 %, three years was 36.9 %, the longest time of follow up was 54 months, and the mean survival time was 20 months. Multi-parameter analysis demonstrated that the patient age, serum total bilirubin, operative duration and volume of blood loss in operation were independent factors to predict the outcome of the hilar cholangiocarcinoma patients. （P = 0. 004 , 0. 012, 0. 021, and 0. 004, respectively）. Conclusions： The patient age, serum total bilirubin, operative duration, and volume of blood loss in operation were independent impact factors to predict the outcome of hilar cholangioearcinoma.