肝癌的Satoh胆管癌栓分型研究

Satoh typing for tumor thrombi in hepatocellular carcinoma with tumor thrombi in the bile duct

目的探讨Satoh癌栓分型对肝细胞性肝癌（以下简称肝癌）合并胆管癌栓手术治疗及预后的预测价值。方法回顾性分析2004年1月至2005年12月第二军医大学东方肝胆外科医院收治的手术治疗的51例肝癌伴胆管癌栓患者的临床资料，比较Satoh分型各型患者的累积无瘤生存率。统计学处理采用SPSS10．0 for windows软件包，统计方法采用Kaplain．Meire法log-rank检验。结果51例没有手术死亡，手术并发症发生率为22％（11／51）。术后1、2年生存率分别为76％（39／51）、55％（28／51）；1、2年无瘤生存率分别为53％（27／51）、22％（11／51）。Ⅰ型的1、2年无瘤生存率分别为61％（19／31）、29％（19／31）；Ⅱ、Ⅲ型1、2年无瘤生存率分别为35％（7／20）、10％（2／20）。生存分析显示Ⅰ型与Ⅱ、Ⅲ型的2年累积无瘤生存率差异有统计学意义（v=7．489，P=0．006）。结论Satoh癌栓分型有助于肝癌合并胆管癌栓手术方案的制定及对预后的判断。

Objective To evaluate Satoh typing for tumor thrombi in the bile duct in patients of hepatocellular carcinoma. Methods A retrospective analysis was made on clinical data of 51 hepatocellular carcinoma patients with tumor thrombi in the bile duct undergoing hepatectomy in Eastern Hepatobiliary Surgery Hospital from Jan 2004 to Dec 2005. The cumulative disease-free survival by the three Satoh types were compared by Kaplain-Meire analysis, and log-rank test. Results There was no operation- related motality and the postoperative complication rate was 22% （ 11/51 ）. The overall survival rates at 1- and 2- years were respectively 76% （39/51） and 55% （28/51）. The overall disease-free survival rates at 1- and 2- years were respectively 53 % （27/51 ） and 22% （ 11/51 ）. The disease-free survival rates at 1- and 2- years in type Ⅰ patients were respectively 61% （ 19/31 ） and 29% （ 19/31 ）. The disease-free survival rates at 1- and 2- years in type Ⅱ and Ⅲ patients were respectively 35% （7/20） and 10% （2/20）. The cumulative disease-free survival rates at 2- years was statistically different between type Ⅰ , type Ⅱ and Ⅲ（v = 7. 489, P = 0. 006） ）. Conclusions Satoh typing of tumor thrombi helps to determine the surgery plan and assess the prognosis of hepatocellular carcinoma with tumor thrombi in the bile duct.