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目的:评估肝门胆管癌根治性切除的治疗效果,分析影响预后的因素。方法 :回顾性分析2004年3月至2014年12月我院肝移植中心单个治疗组手术切除肝门胆管癌病人的临床资料和随访结果 ,分析影响病人预后的因素。结果:166例肝门胆管癌病人接受治疗,其中127例经手术切除,切除率为76.5%。手术切除病人的1、3、5年生存率分别为72.0%、34.0%、20.0%。中位生存时间为22.9个月。术后发生并发症共35例(27.6%),其中死亡3例,2例为肝功能衰竭,1例为消化道大出血,死亡率为2.4%。单因素Log-Rank检测结果显示,手术切缘(χ~2=50.30,P<0.001)、淋巴结转移(χ~2=16.91,P<0.001)、血清总胆红素≥3 mg/d L(χ~2=4.96,P=0.026)及TNM分期(χ~2=30.16,P<0.001)为重要的预后影响因素。多因素分析显示,手术切缘阳性及肿瘤TNM分期差为肝门胆管癌的独立预后不良因素。结论:肝门胆管癌的治疗以手术切除为主,根治性切除(R0切除)是改善病人预后的最佳选择,扩大手术切除范围可提高R0切除率,但需充分的术前评估和准备,以减少术后并发症和死亡率。
Objective: To evaluate the curative effect of radical resection of hilar cholangiocarcinoma and to analyze the factors affecting the prognosis. Methods: The clinical data and follow-up results of surgical resection of hilar cholangiocarcinoma in a single treatment group from March 2004 to December 2014 in our hospital were retrospectively analyzed, and the factors affecting the prognosis were analyzed. Results: 166 cases of hilar cholangiocarcinoma were treated, of which 127 cases were surgically removed, the resection rate was 76.5%. The 1, 3, 5-year survival rates of patients who underwent surgical resection were 72.0%, 34.0% and 20.0%, respectively. The median survival time was 22.9 months. Postoperative complications occurred in 35 cases (27.6%), of which 3 died, 2 were liver failure, and 1 was gastrointestinal hemorrhage with a mortality rate of 2.4%. Logistic regression analysis showed that the operative margin (χ ~ 2 = 50.30, P <0.001), lymph node metastasis (χ ~ 2 = 16.91, P <0.001), serum total bilirubin≥3 mg / d L χ ~ 2 = 4.96, P = 0.026) and TNM stage (χ ~ 2 = 30.16, P <0.001) were significant prognostic factors. Multivariate analysis showed that the positive surgical margins and tumor TNM staging differences in poor prognosis of hilar cholangiocarcinoma. Conclusions: Surgical resection is the main treatment for hilar cholangiocarcinoma. Radical resection (R0 resection) is the best choice to improve the prognosis of patients. Extending the scope of resection can improve R0 resection rate. However, adequate preoperative evaluation and preparation are needed, To reduce postoperative complications and mortality.