老年人肝门部胆管癌的手术治疗方式探讨

Surgical treatment for eldly hilar cholangiocarcinoma

目的探讨手术治疗老年患者肝门部胆管癌的方法。方法将经手术治疗的54例肝门部胆管病例按年龄分为70岁及以上组(A组32例)和70岁以下组(B组22例),对两组临床资料、手术方式、手术并发症及随访资料等进行回顾对比分析。结果本组总切除率为51.9%(28/54),其中根治性切除(R0)率为53.6%(15/28),姑息性切除(R1,R2)率为46.4%(13/28)。A组、B组切除率分别为53.1%(17/32)与50.0%(11/22),差异有统计学意义(χ2=2.98,P=0.08),根治性切除率分别为52.9%(9/17)与54.5%(6/11),差异无统计学意义(χ2=0.006,P=0.93),局部切除比例分别为82.4%(14/17)与54.5%(6/11),差异亦无统计学意义(χ2=2.53,P=0.11),局部切除获根治率分别占57.1%(8/14)与50.0%(3/6),差异有统计学意义(χ2=0.09,P=0.77)。术后两周血清总胆红素与术前相比较,A组(t=5.19,P=0.000)、B组(t=3.67,P=0.007)差异均有统计学意义,但A组与B组比较,术前(t=1.52,P=0.14)与术后(t=0.69,P=0.49)血清胆红素均差异无统计学意义。A组、B组术后发生并发症分别为13例(13/32,40.6%)、6例(6/22,27.3%),两组比较差异无统计学意义(χ2=1.02,P=0.31)。R0切除的中位生存时间为(38.0±9.6)个月,姑息切除为(11.0±2.5)个月,姑息引流为(6.0±3.0)个月,三者间差异均有统计学意义(χ2=11.03,P=0.004),但A组与B组的整体生存率差异无统计学意义(χ2=0.27,P=0.60)。结论年龄不是影响肝门部胆管癌切除与否的因素,局部切除是老年患者外科治疗的首选方式。

Objective To investigate the methods of surgical treatment for eldly hillar cholangiocarcinoma.Methods Fifty-four patients of hillar cholangiocarcinoma were divided into two groups：group A（n=32,70 years old or older） and group B（n=22,younger than 22 years old）.The clinical data,surgical procedures and complications,follow-up data were analyzed and compared between the two groups.Results All the patients were treated surgically.The total excision rate was 51.9%（28/54）,with radically excision rate（R0） of 53.6%（15/28）,and palliative excision rate（R1,R2） of 46.4%（13/28）.The excision rate of group A and group B were 53.1%（17/32） and 50.0%（11/22）,respectively,showing statistically significant difference（χ2=2.98 P=0.08）.No statistically significant difference was found between the two groups in radically excision rates and local excision rates,52.9%（9/17） and 82.4%（14/17） for group A and 54.5%（6/11） and 54.5%（6/11） for group B（χ2=0.006 P=0.93;χ2=2.53,P=0.11）,while statistically significant difference was found in gained radically excision cases 57.1%（8/14） and 50.0%（3/6）,respectively（χ2=0.09 P=0.77）.Two weeks after surgery,statistically significant different was found in totally serum bilirubin of group A（t=5.19,P=0.000） and group B（t=3.67,P=0.007） compared with that before surgery,but not between the two groups preoperatively（t=1.52,P=0.14） and postoperatively（t=0.69,P=0.49）.13 cases showed complications in group A（13/32,40.6%） and 6 cases（6/22,27.3%） in B group,with no statistically significant different（χ2=1.02,P=0.31）.The median survival time was（38.0±9.6） months in R0 excision group,（11.0±2.5） months in palliative excision group,（6.0±3.0） months in drainage group,with statistically significant difference between the three groups（χ2=11.03,P=0.004）.But no statistically significant difference was found in the total survival rates between the two groups（χ2=0.27,P=0.60）.Conclusion Age is not the influence factor for the resection of eldly hillar cholangiocarcinoma.Local resection is proved to be the premium choice for surgical treatment.