肝内胆管癌的治疗和预后因素的分析

Treatment and prognosis of patients with intrahepatic cholangiocarcinoma

目的探讨肝内胆管癌的诊治方法和预后相关因素。方法回顾性分析本院1995年1月～2005年12月手术治疗的86例肝内胆管癌的临床资料，根据不同治疗方法分为两组：肝切除加肝十二脂肠韧带淋巴结常规清扫组（A组）42例，单纯肝切除组（B组）44例，对临床病理因素进行了对比分析。结果A组1、3和5年生存率分别为77．81％、35．21％和20．93％；B组1、3和5年生存率分别为19．82％、2．31％和0％。2组差异有统计学意义（P〈0．01）。手术切除加淋巴结清扫与预后显著相关，47例淋巴结阴性组1、3和5年生存率分别为59．21％、26．21％和20．11％；39例淋巴结阳性组1、3和5年生存率分别为50．21％、11．21％和0％，2纽比较差异有统计学意义（P〈0．01）。结论淋巴结转移和手术切除是影响生存的主要因素，对肝十二指肠韧带淋巴结转移预防性清扫和积极治疗，可延长肝内胆管癌病人的生存率，提高了生活质量。

Objective To investigate the approaches for diagnosis and treatment of intrahepatic cholangiocarcinoma （ICC） and assess its prognosis factors. Methods The clinical data of 86 patients with ICC in our hospital from January 1995 to December 2005 were retrospectively analyzed. All patients were divided into two groups according to the treatment method, including hepateetomy and lymphatic clearance group （Group A, n = 42） and hepatectomy group （Group B, n = 44）, and their clinicopathological variables were analyzed. Results The 1 - ,3 - and 5 - year survival rates were 77.81% and 35.21% , 20. 93% and 19.82% , 2. 31% and 0% respectively between group A and group B. There was significantly difference between these two groups （ P 〈 0. 01 ）. The analysis showed that resection and lymphatic clearance were correlated to prognosis. The 1 - , 3 - and 5 -year survival rates were 59. 21% , 26. 21% , and 20. 11% respectively in 47 patients who were found no lymph node metastasis, and the 1 - , 3 - and 5 -year survival rates were 19.82% , 2. 31% and 0% respectively in 39 patients who were found lymph node metastasis. There was significantly difference in survival rate between group A and group B （ P 〈0. 01 ）. Conclusions Resectability and lymphatic clearance are two significant factors correlated to survival of the patients with ICC. Aggressive treatment of lymph node metastasis in hepatoduodenal ligament is an important strategy to improve survival rates and strengthen patient＇s life quality.