开腹手术治疗肝门部胆管癌疗效及预后影响因素分析

Open surgery in the treatment of patients with hilar cholangiocarcinoma:a study on curative efficacy and prognostic factors

目的:分析肝门部胆管癌(HCCA)手术治疗效果及HCCA患者手术治疗长期预后的影响因素。方法:回顾分析2010年4月至2021年10月于苏州大学附属第一医院行手术治疗的105例HCCA患者的临床资料,其中男性58例,女性47例,年龄(64.2±10.6)岁。总结手术(肝切除、局部胆管切除、姑息引流)、术后病理、围手术期并发症和随访资料,绘制Kaplan-Meier生存曲线,采用log-rank检验和Cox比例风险模型分析影响患者预后因素。结果:105例患者中围手术期死亡4例(3.8%),58例(55.2%)发生并发症,其中胸腔积液32例(30.5%)、胆漏12例(11.4%)。获得随访的85例患者的总体中位生存时间19个月,术后1、3、5年累积生存率分别为58.1%、27.0%、24.8%。其中R 0切除(59例)患者1、3、5年累积生存率分别为69.4%、36.2%、27.4%,明显优于R 1/2切除(20例)患者的49.4%、12.3%、0和姑息性引流患者(6例),差异有统计学意义(均P<0.05)。单因素及Cox多因素分析表明年龄≥70岁(HR=2.158,95%CI:1.175~3.965)、术前肿瘤糖类抗原(CA)19-9≥1015 U/ml(HR=1.981,95%CI:1.009~3.894)、切缘类型(HR=2.587,95%CI:1.371~4.881)、淋巴结转移(HR=2.308,95%CI:1.167~4.567)是影响患者手术预后的独立危险因素(均P<0.05)。结论:R 0切除是延长HCCA患者术后生存时间的有效措施,年龄、术前CA19-9水平、切缘类型、淋巴结转移与HCCA患者手术后生存预后相关。

Objective To study the efficacy of different surgical methods in treatment of hilar cholangiocarcinoma(HCCA),and to analyze the factors affecting long-term prognosis of HCCA patients after surgical treatment.Methods The clinical data of 105 patients who underwent surgical treatment for HCCA at the First Affiliated Hospital of Soochow University from April 2010 to October 2021 were retrospectively analysed.There were 58 males and 47 females,with age(64.2±10.6)years old.Data analysed included surgical treatments,postoperative pathological data,perioperative complications and survival on follow-up.The Kaplan Meier survival curve was plotted,and the log-rank test and Cox proportional hazard model were performed to analyze the key factors affecting long-term prognosis.Results Of 105 patients,4(3.8%)patients died during the perioperative period,and 58 patients(55.2%)developed complications with included 32(30.5%)patients with pleural effusion and 12(11.4%)patients with biliary leakage.The follow-up data was available in 85 patients with the overall median survival time of 19 months,and the 1-,3-,5-year cumulative survival rates of 58.1%,27.0%and 24.8%respectively.The 1-,3-,and 5-year cumulative survival rates for the R0 resection patients(n=59)were 69.4%,36.2%,27.4%,respectively,which were significantly better than 49.4%,12.3%,0%for the R1/2 resection patients(n=20),and 0%for the palliative drainage patients(n=6)(all P<0.05).Univariate analysis and Cox multivariate analysis showed that age≥70 years(HR=2.158,95%CI:1.175-3.965),preoperative CA19-9 level≥1015 U/ml(HR=1.981,95%CI:1.009-3.894),resection margin(HR=2.587,95%CI:1.371-4.881),and lymph node metastasis(HR=2.308,95%CI:1.167-4.567)were independent risk factors for long-term prognosis of HCCA patients(all P<0.05).Conclusions R0 resection was an effective way to prolong survival of patients with HCCA.Age,preoperative CA19-9 level,resection margin and lymph node metastasis were related to long-term survival of HCCA patients.