肝内外恶性梗阻性疾病预后因素分析

Prognostic factors of intrahepatic and extrahepatic malignant obstructive diseases

目的探讨影响肝内外恶性梗阻性疾病预后的因素。方法回顾我科2007年1月-2008年1月收治的无法手术的肝内外恶性梗阻性疾病患者的临床资料,对其中的104例获得完整有效临床随访的患者,采用多变量回归模型进行多因素分析,探讨患者性别、年龄、烟酒嗜好、肿瘤类型、出现梗阻时间、临床症状、血生化指标、治疗方式等因素与预后的关系。结果单因素分析显示：原发病（P=0.009）、血红蛋白（P=0.021）、胆红素（P=0.041）、CA199（P=0.026）、支架治疗（P=0.007）、化疗（P=0.012）、PTCD（P=0.035）与肝内外恶性梗阻性疾病的预后存在相关性。Logistic回归模型进行多因素分析显示,对胆管癌和胰腺癌预后因素及治疗效果有独立影响意义的分别是：胆红素（P=0.041）、支架治疗（P=0.048）;胆红素（P=0.020）、CA199（P=0.049）、化疗（P=0.002）。结论总胆红素〉342μmol/L、CA199〉370 u/mL、支架治疗、化疗是影响肝内外恶性梗阻性疾病患者预后的独立因素。

Objective To investigate the prognostic factors of intrahepatic and extrahepatic malignant obstructive diseases. Methods One hundred and four patients with inoperable intrahepatic and extrahepatic malignant obstructive diseases admitted in our department from January 2007 to January 2008 were retrospectively reviewed.Multivariate logistic regression was used to analyze the influence of age,sex,living habits,tumor type,onset time of obstruction,clinical presentations,lab parameters and treatment choices on the prognosis. Results Univariate analysis suggested that the type of primary disease（P=0.009）,levels of hemoglobin（P=0.021）,bilirubin（P=0.041）,CA199（P=0.026）,stenting treatment（P=0.007）,chemotherapy（P=0.012） and PTCD treatment（P=0.035） were related to the prognosis.According to multivariate logistic regression analysis,bilirubin（P=0.041） and stenting treatment（P=0.048） were independent prognostic factors for bile duct cancer;bilirubin（P=0.020）,CA199（P=0.049）and chemotherapy（P=0.002） were independent prognostic factors for pancreatic cancer. Conclusion The serum level of bilirubin over 342 μmol/L,CA199 over 370 u/mL,stenting treatment and chemotherapy are the independent prognostic factors for patients with inoperable intrahepatic and extrahepatic malignant obstructive diseases.