肝外胆管癌87例临床治疗分析

Analysis of clinical therapeutic efficiency in 87 patients with extrahepatic bile duct cancer

目的:分析不同部位肝外胆管癌的临床特点、手术治疗效果及预后影响因素。方法:回顾性分析2004年5月—2014年4月收治的87例肝外胆管癌患者资料。结果:87例患者中,肝门胆管癌58例,胆总管下端癌29例,患者均以黄疸为主要表现;56例行根治性手术切除,包括肝门胆管癌33例(56.9%,33/58),胆总管下端癌23例(79.3%,23/29),其余患者行姑息性减黄治疗或未予治疗。肝门胆管癌患者根治术后1、2、3年生存率分别为62.2%、35.1%、27.0%;AJCC分期和淋巴转移是总生存期的独立影响因素,而AJCC分期、淋巴转移、肝脏侵犯是无瘤生存期的独立影响因素(均P<0.05)。胆总管下端癌患者术后1、2、3年存活率分别为91.6%、54.2%、37.5%;影响总生存期和无瘤生存期的独立危险因素均为AJCC分期(均P<0.05)。肝门胆管癌与胆总管下端癌患者间,全部患者的总生存期、根治术后患者中位生存期与无瘤生存期及非根治术治疗后患者的中位生存期均无统计学差异(均P>0.05)。结论:对于不同位置的肝外胆管癌,根治性切除均是有效治疗方式,AJCC分期系统可有效评估预后。

Objective： To analyze the clinical characteristics, surgical efficacy and prognostic factors of extrahepatic cholangiocarcinoma in different locations.Methods： The clinical data of 87 patients with cholangiocarcinoma treated from May 2004 to April 2014 were retrospectively analyzed.Results： Of the 87 patients, 58 cases had hilar cholangiocarcinma and 29 cases had distal extrahepatic cholangiocarcinoma, and jaundice was the major symptom among them; 56 cases underwent radical resection, that included 33 cases（56.9%, 33/58） of hilar cholangiocarcinoma and 23 cases（79.3%, 23/29） of distal extrahepatic cholangiocarcinoma, while the remaining cases received either palliative treatment for remission of jaundice or no treatment. In patients with hilar cholangiocarcinoma, the 1-, 2- and 3-year survival rate after radical surgery was 62.2%, 35.1% and 27.0% respectively, the AJCC stage and lymph node metastasis were independentfactors affecting overall survival time, and AJCC stage, lymph node metastasis and liver invasion were independent factors affecting the tumor-free survival time（all P〈0.05）. In those with distal extrahepatic cholangiocarcinoma, the 1-, 2- and 3-year survival rate after radical surgery was 91.6%, 54.2% and 37.5% respectively, and AJCC stage was the only independent factor affecting either overall survival time or tumor-free survival time（both P〈0.05）. Between patients with hilar cholangiocarcinoma and distal extrahepatic cholangiocarcinoma, the median overall survival time in the whole group, the median overall survival time and tumor-free survival time in those undergoing radical resection, and the median overall survival time in those without radical treatment showed no significant difference（all P〉0.05）.Conclusion： For extrahepatic bile duct cancer in different locations, radical resection is the common effective treatment method, and AJCC staging system is effective for estimating the prognosis.