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目的探讨影响肝门部胆管癌根治术患者预后的危险因素。方法回顾性分析2004年1月至2012年2月间陕西省榆林市二院收治的99例接受肝门部胆管癌根治术患者,根据病历记录及术后5年随访结果分为术后生存0~3年组(A组,68例)和术后生存3年以上组(B组,31例)。比较两组患者年龄、性别、病程、手术史、肿瘤直径等临床特征,比较患者的术前糖类抗原19-9(CA19-9)、Bismuth-Corlitte分型、肿瘤分化程度、淋巴结转移情况、门静脉浸润及尾状叶浸润情况;影响预后的多因素分析采用非条件Logistic回归分析。结果 B组患者的肿瘤直径显著小于A组,差异有统计学意义(P<0.05);两组患者在Bismuth-Corlitte分型方面差异无统计学意义(P>0.05)。单因素分析显示,A组患者以术前CA19-9指标>150 U/ml、肿瘤中低分化、淋巴结出现转移、门静脉及尾状叶浸润者居多,与B组患者比较,差异均有统计学意义(均P<0.05)。多因素分析结果显示,肝门部胆管癌根治术后生存期长短与肿瘤直径及术前CA19-9指标呈负相关(均P<0.05),与肿瘤分化程度、淋巴结转移、门静脉浸润及尾状叶浸润呈正相关(均P<0.05)。结论肿瘤直径、淋巴结转移、门静脉浸润、尾状叶浸润、肿瘤分化程度、术前CA19-9等均为影响肝门部胆管癌根治术患者预后的危险因素。
Objective To investigate the risk factors affecting the prognosis of hilar cholangiocarcinoma patients. Methods A retrospective analysis of 99 patients who underwent radical hilar cholangiocarcinoma admitted from January 2004 to February 2012 in Yulin City Second Hospital of Shaanxi Province was performed. According to the records of the medical records and the follow-up results after 5 years, the patients were divided into postoperative 0 ~ 3 years group (A group, 68 cases) and postoperative survival of more than 3 years (B group, 31 cases). The clinical features such as age, sex, course of disease, operation history and tumor diameter were compared between the two groups. Preoperative carbohydrate antigen 19-9 (CA19-9), Bismuth-Corlitte classification, tumor differentiation, lymph node metastasis, Portal vein infiltration and caudate lobe infiltration; multivariate analysis of prognostic factors using unconditional Logistic regression analysis. Results The diameter of tumor in group B was significantly smaller than that in group A (P <0.05). There was no significant difference in the type of Bismuth-Corlitte between the two groups (P> 0.05). Univariate analysis showed that patients in group A had preoperative CA19-9 index of> 150 U / ml, poorly differentiated tumors, lymph node metastasis, mostly portal vein and caudate lobe infiltration, compared with those in group B, the differences were statistically significant Significance (all P <0.05). Multivariate analysis showed that the survival time of hilar cholangiocarcinoma was negatively correlated with tumor diameter and preoperative CA19-9 (all P <0.05), but not with tumor differentiation, lymph node metastasis, portal vein infiltration and caudate Leaf infiltration was positively correlated (all P <0.05). Conclusions Tumor diameter, lymph node metastasis, portal vein infiltration, caudate lobe infiltration, tumor differentiation, preoperative CA19-9 and so on are the risk factors affecting the prognosis of patients with hilar cholangiocarcinoma.