肝外胆管癌的外科治疗与预后分析

Analysis of prognosis after surgical treatment for extrahepatic cholangiocarcinoma

目的:探讨肝外胆管癌(EHCC)的临床特征、治疗方法对远期生存率的影响,分析影响预后的相关因素.方法:对1995-01/2003-12收治的128例EHCC的临床特点、诊断、手术方式和随访结果进行回顾分析.选择对EHCC切除术后预后可能产生影响的临床因素,通过Cox比例风险模型进行多因素的预后分析.结果:107例施行了外科手术,21例非手术治疗.其中,根治性切除47例,姑息性切除12例,内或外引流术45例,探查性手术3例.EHCC整体生存率1,3,5a生存率分别为52.8%,27.2%,11.9%.其中根治性切除1,3,5a生存率分别为72.4%,44.7%,22.7%;姑息性切除1,3,5a生存率分别为54.5%,27.3%,9.1%,无5a存活者.引流组1,3,5a生存率分别为32.1%,17.2%,8.6%,无4a存活者.根治性切除组、姑息性切除组、内或外引流组及非手术组生存率相比较,差异显著(log-ranktest,P<0.001).肿瘤的组织学类型、TNM分期、淋巴结转移、肝脏浸润、胰腺浸润、切缘癌残留、手术切除方式7个因素对预后的影响有统计学差异(P<0.05).结论:根治性切除是提高EHCC远期生存率及改善生活质量的有效手段,早期诊断和治疗是提高远期疗效的关键.淋巴结转移、切缘癌残留是EHCC预后不良的独立危险因素.

AIM：To investigate the effect of clinical features and the prognosis after surgical treatment for extrahepatic cholangiocarcinoma.METHODS：The clinical features,diagnosis,surgical therapy and follow-up result were retrospectively analyzed on 128 cases of EHCC admitted into our hospital from January 1995 to December 2003.A multivariate analysis was performed in these patients by the Cox proportional hazard model.RESULTS：Among 128 patients,107 underwent surgical treatment（radical resection in 47,palliative resection in 12,nonresectional internal or external bile drainage in 45,and only laparatomy in 3）,but 21 did not have surgery.The 1-,3-,5-year survival rates were 52.8%,27.2% and 11.9% in the overall patients and were 72.4%,44.7% and 22.7% in the radical resection group,respectively.The 1-,2-,3-year survival rates were 54.5%,27.3% and 9.1% in palliative resection group,respectively,and none of the patient survived for over 5 years,whereas,in the nonresectional internal or external drainage group,1-,2-,3-year survival rates were 32.1%,17.2% and 8.6%,respectively,and none survived for over 4 years.There were significant differences in the survival rate among the radical resection group,the palliative resection group,nonresectional internal or external drainage group,and non-surgical treatment group（log-rank test,P〈0.001）.The univariate analysis showed that the major significant prognostic factors influencing survival of these patients were histological type of the lesion,TNM stages,lymph node metastasis,involvement of liver,pancreatic invasion,residual tumor margins,and therapeutic interventions（P〈0.05）.CONCLUSION：The radical resection improve the prognosis of EHCC.To improve the survival rate,more attention should be paid to early diagnosis and treatment.After curative resection,lymph node metastasis and residual tumor margins are independent prognostic factors for EHCC.