肝门部胆管癌49例手术并发症分析

Prognostic factors for postoperative complications of hilar cholangiocarcinoma in 49 patients

目的探讨肝门部胆管癌手术并发症的影响因素。方法回顾性分析2000-06至2010-05航天中心医院收治的49例肝门部胆管癌手术的临床资料,并对手术并发症的影响因素进行单因素及多因素分析。结果术后发生并发症23例(46.9%),其中以胆汁漏(28.1%)、腹腔感染(18.8%)、胸腔积液(15.6%)、切口感染(12.5%)为主。围术期死亡3例(6%)。对13个可能影响肝门部胆管癌手术并发症的临床病理指标进行分析,单因素分析显示联合肝切除(P=0.017)、血管切除重建(P=0.026)、手术时间(P=0.033)、Bismuth-Corlette分型(P=0.001)、术中失血量(P=0.003)、术中输红细胞量(P=0.017)组间有统计学差异。多因素分析显示联合肝切除(P=0.011)、手术时间(P=0.027)、术中失血量(P=0.022)是影响术后并发症发生的独立危险因素。结论术前精确评估、围术期精心管理、改进手术技术、减少手术时间及术中失血、采取合适的手术范围,将能明显减少肝门部胆管癌术后并发症发生率。

Objective To analyze prognostic factors for postoperative complications of hilar cholangiocarcinoma（HCC）.Methods A retrospective clinical analysis was conducted in 49 patients with hilar cholangiocarcinoma,who were admitted to Beijing Aerospace Central Hospital between June 2000 and May 2010.Univariate and multivariate analysis was carried out.Results 23patients（46.9%） with HCC experienced postoperative complications,the most common of which was bile leakage（28.1%）,followed by intraabdominal infection（18.8%） and pleural effusion（15.6%） and wound infection（12.5%）.3 patients（6%） died after operatiopn.A total of 13 possible prognostic factors were analyzed.Univariate analysis showed that significant prognostic factors for postoperative complications in patients with HCC were combined hepatectomy（P=0.017）,vascular resection and reconstruction（P=0.026）,operative time（P=0.033）,Bismuth-Corlette（B-C） type（P=0.001）,operative blood loss（P=0.003）,and blood transfusion（P=0.017）.Multivariate analysis indicated combined hepatectomy（P=0.011）,operative time（P=0.027） and operative blood loss（P=0.022）as independent prognostic factors.Conclusion Accurate preoperative assessment,intensive perioperative management,use of time-saving surgical techniques,and the reduction of operative blood loss and the surgical extent for the patients with HCC will significantly reduce the incidence of postoperative complications.