肝门部胆管癌的外科治疗及预后影响因素分析

Surgical Treatment and Infl uence Factors of Prognosis in 189 Cases of Hilar Cholangiocarcinoma

目的总结肝门部胆管癌的治疗并探讨其预后的影响因素。方法回顾性分析2000年1月至2010年12月期间笔者所在医院收治的189例肝门部胆管癌患者的临床资料,采用Cox比例风险模型进行预后影响因素的多因素分析。结果 189例肝门部胆管癌患者中,行根治性手术切除62例,行姑息性手术切除54例,行非切除性手术73例。多因素分析结果显示,手术方式(RR=0.165)、分化程度(RR=2.692)、淋巴结转移(RR=3.014)、神经浸润(RR=2.857)和血管浸润(RR=2.365)均是预后的独立影响因素(P<0.05)。结论根治性切除术是治疗肝门部胆管癌的最佳手术方法,有效的肝十二指肠韧带"骨骼化"、受侵神经和血管的彻底切除是改善患者预后的重要因素。

Objective To summarize the surgical treatment and explore factors which influencing prognosis of hilar cholangiocarcinoma. Methods Clinical data of 189 cases ofhilar cholangiocarcinoma who treated in our hospital from Jan. 2000 to Dec. 2010 and clinicopathological factors that might influence survival were analyzed retrospectively. A multivariate factor analysis was performed through Cox proportional hazard model. Results Of 189 cases, 62 cases received radical resection, 54 cases received palliative surgery, and 73 cases received non-resection surgery. Operative procedure （RR=0. 165）, differentiated degree （RR=2. 692）, lymph node metastasis （RR=3. 014）, neural infiltration （RR=2. 857）, and vascular infiltration （RR=2. 365） were found to be the statistically significant factors that influenced survival by multivariate factor analysis through the Cox proportional hazard model. Conclusions Radical resection is the best treatment for hilar cholangiocarcinoma. Skeletonized hepatoduodenal ligament, complete excision of infiltrated nerve and blood vessel are important influence factors to improve the prognosis ofhilar cholangiocarcinoma.