肝细胞癌合并胆管癌的临床分型以及手术方式选择对疾病预后的影响

Clinical Classification of Hepatocellular Carcinoma with Bile Duct Cancer and Effect of Surgical Choice on Prognosis

目的探讨肝细胞癌合并胆管癌的临床特征分型及手术治疗方式选择对远期效果的影响。方法回顾性分析100例肝细胞癌合并胆管癌患者的就诊资料、肿瘤临床分型及手术方式、生存资料,手术方式有胆管切开取癌栓、肝癌切除并胆管癌切除、胆管支架置入引流等,分析不同手术方式对远期预后的影响。结果 100例确诊并进行根治手术治疗的患者有92例,其中肝细胞癌切除并胆管切口取癌栓的有38例,肝细胞癌切除并胆管癌切除的有48例,胆管支架植入引流的有6例,术后围手术期死亡的患者有9例,25例出现围手术并发症,术后1年、2年、3年的生存率分别为63.0%、25.0%、19.6%,生存期平均为(20.6±10.6)个月。通过单因素分析结果显示肝细胞癌合并胆管癌生存期与临床分型及手术方式选择有关。多因素分析结果显示手术方式的选择为影响生存期的独立因素。结论手术方式的选择是影响肝细胞癌合并胆管癌治疗效果的重要因素。若能早期发现病灶并选择合理的手术方式进行根治,对于延长患者生存期具有重要的意义。

Objective To investigate the clinical characteristics of hepatocellular carcinoma with cholangiocarcinoma and the effect of surgical treatment on long-term outcome. Methods Retrospective analysis of treatment data, clinical classifica- tion of tumors and surgical methods, survival data of 100 cases of hepatocellular carcinoma patients with cholangiocarcinoma were conducted, surgical treatment included surgical removal of bile duct tumor thrombectomy, hepatectomy and bile duct resection, bil- iary stenting drainage,etc. ,the impact of different surgical methods on long-term prognosis were analyzed. Results Of the 100 patients,92 cases were diagnosed and underwent radical surgery,there were 38 cases received surgical removal of bile duct tumor thrombectomy,48 cases received hepatectomy and bile duct resection, 6 cases received biliary stenting drainage. Perioperative death after surgery were 9 cases, and postoperative perioperative complications 25 cases. !-, 2- and 3-year survival rates were 63.0% ,25.0% ,19.6% ,and the average survival time was （20.6 ＋ 10.6） months. Univariate analysis showed that survival of hepatocellular carcinoma with cholangiocarcinoma was associated with clinical classification and surgical choice. Multivariate anal- ysis showed that the choice of surgical methods was risk factor affecting the survival of patients. Conclusion The choice of surgi- cal methods is an important factor affecting the efficacy of hepatocellular carcinoma with cholangiocarcinoma. Early detection of le- sions and selection of reasonable surgical approach have significance in prolong survival of patients.