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中华肝脏外科手术学电子杂志 ›› 2017, Vol. 06 ›› Issue (06) : 464 -468. doi: 10.3877/cma.j.issn.2095-3232.2017.06.011

所属专题: 文献

临床研究

389例肝门部胆管癌外科治疗回顾性分析——单中心11年经验总结
张东1, 李文智1, 陶杰1, 陈晨1, 王林1, 石磊1, 孙昊1, 刘青光1, 吕毅1, 刘昌1, 仵正1, 耿智敏1,()   
  1. 1. 710061 西安交通大学第一附属医院肝胆外科
  • 收稿日期:2017-08-23 出版日期:2017-12-10
  • 通信作者: 耿智敏
  • 基金资助:
    国家自然科学基金(81572420)

Retrospective analysis of surgical treatment for 389 patients with hilar cholangiocarcinoma: a single-center 11-year experience

Dong Zhang1, Wenzhi Li1, Jie Tao1, Chen Chen1, Lin Wang1, Lei Shi1, Hao Sun1, Qingguang Liu1, Yi Lyu1, Chang Liu1, Zheng Wu1, Zhimin Geng1,()   

  1. 1. Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
  • Received:2017-08-23 Published:2017-12-10
  • Corresponding author: Zhimin Geng
  • About author:
    Corresponding author: Geng Zhimin, Email:
引用本文:

张东, 李文智, 陶杰, 陈晨, 王林, 石磊, 孙昊, 刘青光, 吕毅, 刘昌, 仵正, 耿智敏. 389例肝门部胆管癌外科治疗回顾性分析——单中心11年经验总结[J]. 中华肝脏外科手术学电子杂志, 2017, 06(06): 464-468.

Dong Zhang, Wenzhi Li, Jie Tao, Chen Chen, Lin Wang, Lei Shi, Hao Sun, Qingguang Liu, Yi Lyu, Chang Liu, Zheng Wu, Zhimin Geng. Retrospective analysis of surgical treatment for 389 patients with hilar cholangiocarcinoma: a single-center 11-year experience[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2017, 06(06): 464-468.

目的

探讨肝门部胆管癌的外科治疗及其预后影响因素。

方法

回顾性分析2003年1月至2013年12月西安交通大学第一附属医院收治的389例肝门部胆管癌患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男208例,女181例;平均年龄(59±12)岁。合并胆管炎22例,肝内胆管结石5例,胆囊结石7例。分析患者治疗方式及疗效。率的比较采用χ2检验,生存分析采用Kaplan-Meier法和Log-rank检验。

结果

根治性切除132例,姑息性切除134例,姑息性减黄治疗123例。2008~2013年根治切除率和联合半肝切除率分别为56%(104/187)和31%(58/187),明显高于2003~2007年的35%(28/79)和6%(5/79) (χ2=9.04,18.73;P<0.05)。联合半肝切除患者中,术前减黄组肝功能不全发生率为26%(6/23),明显低于未减黄组的45%(18/40) (χ2=4.58,P<0.05)。术前减黄组胆道感染发生率为35%(8/23),明显高于未减黄组的8%(3/40) (χ2=7.54,P<0.05)。姑息性减黄治疗患者中,ERCP组术后胆管炎发生率为38%(16/42),明显高于经皮经肝穿刺胆管引流术(PTBD)组的14%(10/71) (χ2=8.59,P<0.05)。单纯根治性切除患者术后1、2、3年总体生存率分别为72%、40%、23%,联合半肝切除相应为81%、46%、31%,两组总体生存率差异有统计学意义(χ2=4.68,P<0.05)。TNM分期、切缘残留肿瘤细胞及淋巴结转移与根治性切除患者预后相关(χ2=24.66,80.31,57.81;P<0.05)。

结论

近年肝门部胆管癌根治性切除率提高,术前减黄可降低联合半肝切除患者肝功能不全发生率。与PTBD相比,ERCP姑息性减黄治疗具有胆道感染发生率低的优势。联合半肝切除患者生存优于单纯根治性切除。

Objective

To investigate the surgical treatments and prognostics influencing factors for hilar cholangiocarcinoma.

Methods

Clinical data of 389 patients with hilar cholangiocarcinoma who were admitted to the First Affiliated Hospital of Xi'an Jiaotong University between January 2003 and December 2013 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 208 cases were male and 181 were female, aged (59±12) years old on average. Twenty-two cases were combined with cholangitis, 5 with intrahepatic biliary calculi and 7 with cholecystolithiasis. The treatment methods and curative effects were analyzed. The rates were compared by Chi-square test. The survival analysis was conducted by Kaplan-Meier method and Log-rank test.

Results

Radical resection was performed in 132 cases, palliative resection in 134 cases and palliative jaundice reduction in 123 cases. The radical resection rate and combined hemihepatectomy rate was respectively 56%(104/187) and 31%(58/187) between 2008 and 2013, significantly higher than 35%(28/79) and 6%(5/79) between 2003 and 2007 (χ2=9.04, 18.73; P<0.05). Among the patients with combined hemihepatectomy, the incidence of hepatic insufficiency in the preoperative jaundice reduction group was 26%(6/23), significantly lower than 45%(18/40) in the non-jaundice reduction group (χ2=4.58, P<0.05). The incidence of biliary tract infection in the preoperative jaundice reduction group was 35%(8/23), significantly higher than 8%(3/40) in the non-jaundice reduction group (χ2=7.54, P<0.05). Among the patients with palliative jaundice reduction treatment, the incidence of cholangitis in the ERCP group was 38%(16/42), significantly higher than 14%(10/71) in the percutaneous transhepatic biliary drainage (PTBD) group (χ2=8.59, P<0.05). The postoperative 1, 2, 3-year overall survival rate was respectively 72%, 40%, 23% in the patients with simple radical resection, and was correspongdingly 81%, 46% and 31% in the patients with combined hemihepatectomy, and significant difference was observed in the overall survival rate between two groups (χ2=4.68, P<0.05). The TNM stage, residual tumor cells at incisal margin and lymph node metastasis were correlated with the prognosis of patients with radical resection (χ2=24.66, 80.31, 57.81; P<0.05).

Conclusions

Radical resection rate of hilar cholangiocarcinoma has been increased in recent years. Preoperative jaundice reduction can reduce incidence of hepatic insufficiency in patients with combined hemihepatectomy. Compared with PTBD, ERCP palliative jaundice reduction has the advantage of lower biliary tract infection rate. The survival rate of patients with combined hemihepatectomy is better than that of patients with simple radical resection.

表1 132例肝门部胆管癌患者Bismuth-Corlette分型及根治性切除情况(例)
图1 单纯根治性切除和联合半肝切除肝门部胆管癌患者Kaplan-Meier生存曲线
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