肝门部胆管癌的外科治疗和预后因素分析

Cholangiocarcinoma of the hepatic hilum： surgical management and prognosis

目的探讨肝门部胆管癌（hilar cholangiocarcinoma，HCC）的外科治疗特点及预后因素，以期进一步提高HCC外科疗效。方法回顾性分析72例病理诊断为HCC患者的临床资料，分析手术方式、肿瘤病理类型与预后的关系。结果不同手术方式术后3年生存率、s年生存率及中位生存期差异有统计学意义（X2=28．1，P〈0．01）；单因素分析发现，手术方式、淋巴结转移、切缘阳性及肿瘤病理类型及分化程度是影响预后的因素；Cox模型多因素分析，结果显示手术方式、肿瘤病理类型及分化程度以及淋巴结转移是影响预后的独立因素（回归系数分别为1．4157、1．1072、1．6435）。结论根治性切除及彻底的淋巴结清扫是改善肝门部胆管癌预后的重要措施。

Objective To analyze the surgical management and prognosis of hilar cholangiocarci- noma（HCC）. Method Clinical data of 72 patients with HCC were retrospectively analyzed. Results There was a significant difference in the 3- and 5- year survival rates and median survivals among the groups treated with different surgical methods（X2=28.1, P〈0.01）. Univariate analyses conducted for the 16 factors which might affect prognosis showed the surgical method, lymphatic metastasis, positive margin, as well as the type of pathology and staging were of statistically significant prognostic value （P〈0.05）. On a multivariate analysis using the Cox proportional hazards model, surgical management, lymphatic metastasis and the type of pathology and staging were independent prognostic factors （regression coefficient 1. 4157, 1. 1072, 1. 6435）. Conclusion Radical excision is an important prognostic factor for HCCs and extended resection improved the long-term survival rates of radical surgery.