不同手术方法治疗肝内胆管癌的临床效果评价及预后危险因素分析

Clinical Evaluation of Different Surgical Methods in the Treatment of Intrahepatic Cholangiocarcinoma and Analysis of Prognostic Factors

目的探讨不同手术方法治疗肝内胆管癌的临床效果及影响预后的危险因素分析。方法选取肝内胆管癌患者106例,所有患者行术前诊断评估,并根据不同的手术治疗方法分为手术根治切除治疗(根治组)、姑息性切除与辅助治疗(姑息治疗组)、对症治疗(经皮途径也能完成胆道引流)(对症治疗组),并对不同手术切缘的生存率及影响预后的因素进行分析。结果根治组患者的预后优于姑息治疗组,姑息治疗组患者的预后优于对症治疗组,生存率及中位生存时间由高到低为手术根治组>姑息治疗组>对症治疗组。单因素分析发现术前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);行Cox回归分析发现,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预后因素。手术方式及手术切缘对预后均有影响。结论肝内胆管癌患者术前完善各项相关检查,对疾病的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 explore the clinical effect of different surgical methods in the treatment of intrahepatic cholangiocarcinoma and the risk factors of prognosis. Methods 106 patients with intrahepatie eholangioearcinoma were enrolled in this study. All patients underwent preoperative diagnostic evaluation and were divided into surgical radical resection group and palliative treatment group（palliative resection and adjuvant therapy） , and symptomatic treatment group （percutaneous route can also complete the bile duct drainage） , and the survival rate of different surgical margins and the impact of prognostic factors. Results The prognosis of the patients in the treatment group was better than that of the palliative treatment group. The prognosis of the pal- liative treatment group was better than that of the treatment group. The survival rate and the median survival time were from high to low the treatment group palliative treatment group symptomatic treatment group（ P 〈 0.05 ）. Single factor analysis showed that CA19-9, ALT and lymph node metastasis were associated with prognosis （ P 〈 0.05 ）. Gender, age, cirrhosis, albumin and combined stones were not correlated with prognosis （P 〉 0.05 ）. Cox regression analysis found that lymph node metastasis, CA19-9, AJCC stage, tumor recurrence and alanine aminotransferase were long-term survival prognostic factors of patients with intrahepatic cholangiocarcinoma. Surgical methods and surgical margins had an impact on prognosis. Conclusion The patients with intrabepatic cholangiocarcinoma can improve the prognosis of the patients by radical treatment. The diagnosis of intrahepatic cholangiocarcinoma can be used to evaluate the prognosis of patients with intrahepatic cholangiocarcinoma.