胆管癌的病理学特征对手术后远期效果的影响

The Effects of Pathologic Characteristic on Long Term Resultsof Surgical Treatment in Cholangiocarcinoma

为了探讨胆管癌的病理学特征对其预后的影响，提高外科治疗的远期效果，我们在总结手术治疗１０３例肝门部胆管癌的基础上，对７２例有病理诊断者进行了回顾分析；并重新对７８例肝外胆管癌的石蜡包埋标本，进行Ｋｉ－６７核蛋白表达的研究。结果显示：肝门部胆管癌的病理分化程度越低胆管癌对周围神经、脂肪组织的浸润及淋巴结转移率越高，预后较差的中低分化及粘液腺癌所占的比例高达４７．２％，手术后长期生存者均为高分化腺癌。并发现胆管癌不同组织类型与分化程度与Ｋｉ－６７核蛋白表达呈明显的相关性，即分化程度越差Ｋｉ－６７核蛋白表达越强。结论提示：胆管癌的病理组织类型对预后有明显影响；

In order to study the effects of pathologic characteristic on the results of surgical treatment in cholangiocarcinoma, we retrospecitvely analysed the pathologic diagnosis of 72 cases in 103 patients with hilar cholangiocarcinoma treated surgically in our hospital, meanwhile, the expression of the Ki67 nucleoprotein was investigated in 78 extrahepatic bile duct carcinomas with an immunohistochemical technique on formalinfixed, paraffin embedded tissue sections. We found that the pathological typing had obvious effect on the prognosis of hilar cholangiocarcinoma. The poorer differentiated bile adenocarcinoma had higher involvement in perineural bundles, fat tissue and lymphatic systems. In this series, moderately and poorly differentiated carcinomas and mucinous adenocarcinoma accounted for 47.2% of bile duct carcinomas. The patients with welldifferentiated adenocarcinoma had the best outcome. The results suggest that the expression of the Ki67 antigen has a strong correlation with the pathologic typing and grades of differentiation of the carcinomas. Thus, the Ki67 nucleoprotein is considered a potential prognostic factor.