31例肝内胆管细胞癌的临床和预后分析

Clinical Analysis of Patients with Cholangiocarcinoma (A Report of 31 Cases)

目的：评价胆管细胞癌的临床特点和治疗方法及两者与预后的关系，以指导临床诊治，提高生存期。方法：回顾分析我所1980～1997年收治的31例胆管细胞癌患者的临床资料，所有患者均获得随访。结果：31例患者中HBsAg阳性率为22.6％，AFP阳性率为16.1％。1，3和5年生存率分别为43.4％，13.3％和6.7％。用Cox比例风险模型单因素分析，手术切除、肝门周围淋巴结转移是影响预后的最重要因素（P＜0.001）；多因素分析，肝硬变程度（P＝0.03）、手术切除（P＜0001）、肝门周围淋巴结转移（P＝0.049）是影响预后的最重要因素。结论：HBsAg、AFP阴性、肝门淋巴结转移对诊断胆管细胞癌有重要价值。手术切除能明显改善预后，延长生存期。应重视伴有淋巴结转移的胆管细胞癌的研究。

objective: To evaluate the clinical characteristics and different therapeutic methods of cholangiocarcinoma, and their correlation with prognosis for guiding clinical diagnosis and treatment. Materials and Methods: Clinical data from 1980 to 1997 of 31 patients with cholangiocarcinoma were collected and summarized, whose clinical characterictics and prognosis were analyzed retrospectively. Follow - up data were avalaible for all the patients. Results: Among all the patients, the positive rate of HBsAg and AFP were 22. 6 % and 16. 1 % respectively. The 1, 3 and 5 - year survival rate were 43. 4 % , 13. 3 % and 6. 7 %. Univariate analysis using Cox's hazards model revealed that operative removal and lymphatic metastasis around hepatic hilum were statistically significant indepindent prognostic factors (P < 0. 001). Multivariate analysis showed that liver cirrhosis (P = 0. 03), operative removal (P < 0. 001 ) and lymphatic metastasis around hepatic hilum (P = 0. 049) were statistically significant indepindent prognostic factors. Conclusions: Negative HBsAg and AFP, and lymphtic metastasis around hepatic hilum are helpful for the diagnosis of cholangiocarcinoma. Operative removal can improve the survival. More attention should be payed to the research of cholangiocarcinoma with lymphatic metastasis.