肝门胆管癌不同手术方案治疗的临床效果及预后影响因素分析

Clinical Effect of Different Surgical Methods for Hepatic Portal Cholangiocarcinoma and Prognostic Factors

目的探究不同的手术方案治疗肝门胆管癌(HC)的临床效果及影响患者预后的危险因素。方法回顾性分析90例肝门胆管癌患者的临床资料,依据手术方案不同分为经内镜逆行胰胆管造影术(ERCP)组42例及经皮经肝穿刺胆管引流术(PTCD)组48例,分析不同手术方案治疗HC的临床效果。将2组术后无明显并发症预后良好的62例患者纳入预后良好组,将14例预后不佳患者纳入预后不良组,分析影响预后的相关危险因素。结果ERCP组并发症发生率低于PTCD组,差异有统计学意义(P<0.05)。预后不良组糖类抗原199(CA199)>27 U/ml、谷丙氨酸转移酶(ALT)>40 U/L、多发性肿瘤、已发生淋巴结转移及血管侵犯发生率均高于预后良好组,差异有统计学意义(P<0.05);Logistic回归分析显示,CA199高水平、ALT高水平、肿瘤多发、淋巴结转移及血管侵犯是手术治疗HC患者预后的独立危险因素(P<0.05)。结论临床对于HC应采用ERCP手术,严格遵循手术适应证,可依据术前检查结果制定更加详细的治疗方案,以改善预后。

Objective To explore the clinical effect of hepatic portal cholangiocarcinoma(HC)and the risk factors affecting patient prognosis.Methods Clinical data of 90 patients were analyzed retrospectively,which were divided into 42 intransendoscopic retrograde cholangiography(ERCP)and 48 in percutaneous biliary drainage(PTCD).The ERCP group was treated with ERCP,and the PTCD group was treated with PTCD.The clinical effects of different surgical modalities for HC were analyzed.62 patients with good prognosis without significant postoperative complications were included in the good prognosis group,14 patients with poor prognosis were included in the poor prognosis group,and the relevant risk factors affecting prognosis were analyzed.Results The incidence of complications was lower in the ERCP group than in the PTCD group,The difference was statistical significant(P<0.05);In the poor prognosis group,glucose antigen 199(CA199)>27 U/ml,glutamate alanine transferase(ALT)>40 U/L,multiple tumors,existing lymph node metastases and vascular invasion were all higher than the good prognosis group,The difference was statistical significant(P<0.05);Logistic regression analysis showed that,high level of CA199 and ALT,form of tumorigenesis,lymph node metastasis,and vascular invasion are independent risk factors affecting the outcome of surgical treatment of patients with HC(P<0.05).Conclusion ERCP surgery should be used for HC,strictly follow the surgical indications,and a more detailed treatment plan can be formulated based on the preoperative examination results to improve the prognosis.