Ⅲ、Ⅳ型肝门部胆管癌局限性切除和扩大肝切除疗效比较

Comparison of clinical efficacy between limited resection and extended hepatectomy for type Ⅲ and Ⅳ hilar cholangiocarcinoma

目的比较Ⅲ、Ⅳ型肝门部胆管癌局限性切除和扩大肝切除疗效。方法回顾性分析2010年2月至2014年10月在广州医科大学附属第二医院收治的73例Ⅲ、Ⅳ型肝门部胆管癌患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男47例,女26例;平均年龄(54±6)岁。根据不同手术方式将患者分为局限组和扩大组,局限组采用肝门区域不规则切除,扩大组采用半肝联合尾状叶切除。两组患者肿瘤切除率和并发症发生率等比较采用χ~2检验或Fisher确切概率法。生存分析采用Kaplan-Meier生存曲线和Log-rank检验。结果扩大组肿瘤切除率为90%(37/41),明显高于局限组的53%(17/32)(χ~2=2.650,P<0.05)。两组患者出血、感染、胆漏、胸腔积液、肝衰竭发生率比较差异无统计学意义(P>0.05)。扩大组患者术后1、3、5年生存率分别为82%、38%、15%,明显高于局限组的58%、16%、3%(χ~2=4.869,4.221,4.607;P<0.05)。扩大组中位生存时间为32个月,局限组20个月,扩大组总体生存明显优于局限组(χ~2=2.825,P<0.05)。结论相对于局限性切除术,扩大肝切除术可提高Ⅲ、Ⅳ型肝门部胆管癌患者肿瘤切除率和生存率,并不增加术后并发症发生率。

Objective To compare the clinical efficacy between limited resection and extended hepatectomy for type Ⅲ and Ⅳ hilar cholangiocarcinoma.Methods Clinical data of 73 patients with type Ⅲ and Ⅳ hilar cholangiocarcinoma admitted to the Second Affiliated Hospital of Guangzhou Medical University from February 2010 to October 2014 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,47 cases were male and 26 were female,aged(54±6)years on average.According to different surgical procedure,the patients were divided into the limited and extended groups.In limited group,irregular resection of portal region was performed,and hemihepatectomy combined with caudate lobectomy was performed in extended group.The tumor resection rate and incidence of complications were compared between two groups by Chi-square test or Fisher's exact probability test.Survival analysis was conducted with Kaplan-Meier survival curve and Log-rank test.Results The tumor resection rate in extended group was 90%(37/41),significantly higher than 53%(17/32)in limited group(χ2=2.650,P<0.05).The incidence of bleeding,infection,bile leakage,pleural effusion and liver failure did not significantly differ between two groups(P >0.05).The 1-,3-,and 5-year survival rates in extended group were 82%,38%,and 15%,significantly higher than 58%,16%and 3%in limited group(χ2=4.869,4.221,4.607;P<0.05).The median survival time was 32 months in extended group and 20 months in limited group.The overall survival in extended group was significantly better than that in limited group(χ2=2.825,P<0.05).Conclusions Compared with limited resection,extended hepatectomy can improve the tumor resection rate and survival rate of patients with typeⅢandⅣhilar cholangiocarcinoma,whereas does not increase the incidence of postoperative complications.