肝门部胆管癌外科手术治疗效果及患者生存状况影响因素分析

Analysis of Surgical Effect and Survival Factors of Hepatic Portal Cholangiocarcinoma

目的分析肝门部胆管癌(HCCA)外科手术治疗效果及生存状况的影响因素。方法选择进行手术治疗的145例HCCA患者,收集患者一般资料及围手术期资料,术后随访24个月。分析HCCA外科手术治疗效果,统计患者2年总生存率(OS),分析影响患者生存状况的危险因素。结果根治性切除患者2年OS高于胆管引流术、姑息性切除,有统计学差异(P<0.05);姑息性切除患者2年OS与胆管引流术比较,无统计学差异(P>0.05)。死亡组TBIL≥10 mg/dl、TNM分期Ⅲ期+Ⅳ期、胆管引流术、淋巴结转移、低分化、门静脉侵犯患者占比高于存活组,有统计学差异(P<0.05);2组在年龄、性别、CA199、Bismuth-Corlette分型、肿瘤大小方面比较,无统计学差异(P>0.05);Logistic回归分析显示,TBIL、TNM分期、手术方式、淋巴结转移、分化程度、门静脉侵犯是影响患者生存状况的独立因素(P<0.05且OR≥1)。结论HCCA患者采用根治性切除治疗后2年OS相对较高。HCCA患者生存状况受TBIL、TNM分期、手术方式、淋巴结转移、分化程度、门静脉侵犯等影响,临床可针对上述因素对患者预后进行评估,优化HCCA的治疗策略。

Objective To analyze the surgical treatment effect and survival factors of hepatic portal cholangiocarcinoma(HCCA).Methods The 145 HCCA patients were selected.All of the 145 patients were treated surgically,collected general data and perioperative data,and were followed up for 24 months later.The surgical treatment effect of HCCA was analyzed,the two-year overall survival rate(OS)was counted,and the risk factors affecting their survival status were analyzed.Results OS was higher than bile duct drainage and palliative resection,Statistical difference(P<0.05);Comparative of 2-year OS with bile duct drainage in patients with palliative resection,No statistical difference(P>0.05);The proportion of patients with TBIL 10 mg/dl,TNM stage+stage,bile duct drainage,lymph node metastasis,low differentiation,and portal invasion was higher than that in the surviving group,Statistical difference(P<0.05);The two groups were compared in terms of age,sex,CA199,Bismuth-Corlette typing,and tumor size,there had no statistical difference(P>0.05);The Logistic regression analysis showed that,TBIL,TNM stage,surgical mode,lymph node metastasis,degree of differentiation,and portal invasion are the independent factors for patient survival(P<0.05 and OR≥1).Conclusion The radical resection in HCCA patients has relatively high OS,and the survival status of HCCA patients is affected by TBIL,TNM stage,surgical mode,lymph node metastasis,the degree of differentiation,portal vein invasion,etc.Evaluation of the above risk factors can provide a reference for optimizing the treatment strategy of HCCA.