肝内胆管癌术前诊断评估及临床治疗对预后的影响

Effect of Preoperative Diagnosis and Evaluation of Intrahepatic Cholangiocarcinoma and Clinical Treatment on Prognosis

目的探讨术前诊断评估及临床治疗对肝内胆管癌患者预后的影响。方法选取肝内胆管癌患者106例,所有患者行术前诊断评估,并对治疗后影响预后的因素进行分析。结果肝内胆管癌患者超声检查、CT检查以及MRI检查准确率分别为78.2%、86.8%和91.5%,差异有统计学意义(P<0.05)。术前辅助检查结果单因素分析发现CA19-9、ALT以及淋巴结转移与预后相关(P<0.05),患者的性别、年龄、肝硬化、白蛋白以及合并结石与预后无关(P>0.05)。106例肝内胆管癌总生存影响因素行Cox回归分析发现,手术方式、淋巴结转移、CA19-9、AJCC分期、肿瘤多发以及谷丙转氨酶为肝内胆管癌患者长期生存不良预后因素。肝内胆管癌采用根治术后1年、3年以及5年生存率显著高于非根治手术或保守非手术治疗,差异具统计学意义(P<0.05)。结论肝内胆管癌患者术前完善各项相关检查,对疾病准确诊断评估具参考价值,根治性手术治疗可明显改善患者预后。

Objective To investigate the effect of preoperative diagnosis and evaluation of intrahepatic bile duct cancer and clinical treatment on the prognosis. Methods 106 patients with intrahepatic bile duct cancer were evaluated before opera- tion, and the factors affecting prognosis were analyzed. Results The diagnosis accuracy of B-mode uhrasonography, CT, MRI were 78.2% ,86.8% and 91.5% ,respectively,and the single factor analysis results showed that CA19-9 ,ALT and lymph node metas- tasis were related to prognosis（ P 〈 0.05 ）, gender, age, liver cirrhosis, albumin, and prognosis were not associated with prognosis （P 〉 0.05 ）. Cox regression analysis was performed on 106 patients with intrahepatic bile duct carcinoma, and the results showed that the operation mode,lymph node metastasis, CA19-9, AJCC staging, tumor multiple and alanine aminotransferase were the ad- verse prognostic factors for long-term survival of patients with intrahepatic bile duct cancer. The 1-, 3-and 5-year survival rate of intrahepatie bile duet carcinoma treated with radical operation were significantly higher than those without radical operation or conservative treatment, and the difference was statistically significant （ P 〈 0.05 ）. Conclusion Improve the relevant examination of patients with intrahepatic bile duct carcinoma provide a reference value for the diagnosis and evaluation of the disease, radical operation can significantly improve the prognosis of patients with intrahepatic bile duct carcinoma.