肝门部胆管癌姑息治疗的效果及预后分析:附218例报告

Clinical effects and outcomes of palliative therapy to hilar cholangiocarcinoma:a report of 218 cases

目的:探讨肝门部胆管癌姑息治疗的临床效果及预后。方法:回顾性分析2005年12月—2015年11月中南大学湘雅医院收治的218例肝门部胆管癌患者的临床及病理资料。结果:218例患者中,159例行姑息性手术(72.9%),包括胆道外引流术134例,胆肠内引流术25例;59例行介入治疗(27.1%),包括经皮肝穿刺胆道引流术(PTBD)27例,内镜下胆道支架置入术(ERBD)32例。2例术后30d内死亡;姑息性手术与介入治疗患者术后总胆红素均明显下降(均P<0.05)。202例获随访,随访期间196例死亡。全组患者的中位生存时间和1、3、5年生存率为7个月和29.9%、8.1%、2.3%,其中姑息性手术患者为7个月和33.8%、10.3%、2.9%;介入治疗患者为7个月和14.9%、0、0,两者差异有统计学意义(χ~2=5.328,P<0.05)。胆道外引流患者与胆肠内引流患者间生存率及PTBD患者与ERBD患者生存率差异均无统计学意义(χ~2=0.673;χ~2=0.023,均P>0.05)。结论:肝门部胆管癌姑息治疗的远期疗效不佳,姑息性手术与介入治疗均能有效减黄,姑息性手术患者生存率高于介入治疗;介入治疗的方法简单、对患者创伤小。

Objective： To investigate the clinical effects and outcomes of palliative therapy in treatment of hilar cholangiocarcinoma. Methods： ~he clinical data of 218 patients with hilar cholangiocarcinoma treated in Xiangya Hospital of Central South University between December 2005 and November 2015 were retrospectively analyzed. Results： Of the 218 patients, 159 cases （72.9%） underwent palliative surgery that included external biliary drainage in 134 cases and internal biliary drainage in 25 treatment that included percutaneous transhepatic biliary biliary drainage （ERBD） in 32 cases. Two patients died cases, and S9 cases （27.1%） underwent interventional drainage （PTBD） in 27 cases and endoscopic retrograde within postoperative 30 d, and the total bilirubin levels were decreased significantly in patients either after palliative surgery or interventional treatment （both P〈0.05）. Two hundred and two patients were followed up and 196 patients died during this period. The median survival time, and the 1-, 3- and 5-year survival rates were 7 months, and 29.9%, 8.1% and 2.3% in the entire group of patients, which were 7 months, 33.8%, 10.3% and 2.9% in patients undergoing palliative surgery, and 7 months, 14.9%, 0 and 0 in patients undergoing interventional treatment, and the difference between the latter two groups had statistical significance （χ^2=5.328, P〈0.05）. The survival rates between patients undergoing external biliary drainage and internal biliary drainage, or between patients undergoing PTBD and ERBD showed no statistical difference （χ^2=0.673; χ^2=0.023, both P〉0.0S）. Conclusion： The long-term outcomes of palliative therapy for hilar cholangiocarcinoma are unfavorable. Both palliative surgery and interventional treatment have jaundice reduction effect, and survival rates in patients after palliative surgery are higher than those after interventional treatment, while interventional treatment has the advantages of simple operation and less trauma.