肝切除联合淋巴结清扫对临床淋巴结阴性肝内胆管癌患者预后的价值

doi:10.3877/cma.j.issn.2095-3232.2020.06.008

中华肝脏外科手术学电子杂志 ›› 2020, Vol. 09 ›› Issue (06) : 533 -537. doi: 10.3877/cma.j.issn.2095-3232.2020.06.008

所属专题：文献；

临床研究

肝切除联合淋巴结清扫对临床淋巴结阴性肝内胆管癌患者预后的价值

黄徐建¹, 杨发才¹, 李梦¹, 刘小鹏¹, 陈泰安¹, 何毅¹, 李强¹, 徐建¹, 杨刚¹, 邬长康¹, 熊永福¹, 李敬东¹^,^†(

)

^1. 617000　四川省南充市，川北医学院附属医院肝胆外一科　川北医学院肝胆胰肠疾病研究所

收稿日期:2020-07-06 出版日期:2020-12-10
通信作者: 李敬东
基金资助:
四川省科技计划项目(2019YJ0384); 南充市科技战略合作项目(NSMC20170413)

Prognostic value of hepatectomy combined with lymph node dissection in patients with intrahepatic cholangiocarcinoma and clinical negative lymph node metastasis

Xujian Huang¹, Facai Yang¹, Meng Li¹, Xiaopeng Liu¹, Taian Chen¹, Yi He¹, Qiang Li¹, Jian Xu¹, Gang Yang¹, Changkang Wu¹, Yongfu Xiong¹, Jingdong Li¹^,^†()

^1. Department Ⅰ of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Institute of Hepatobiliary, Pancreatic and Intestinal Diseases of North Sichuan Medical College, Nanchong 617000, China

Received:2020-07-06 Published:2020-12-10
Corresponding author: Jingdong Li

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引用本文：

黄徐建, 杨发才, 李梦, 刘小鹏, 陈泰安, 何毅, 李强, 徐建, 杨刚, 邬长康, 熊永福, 李敬东. 肝切除联合淋巴结清扫对临床淋巴结阴性肝内胆管癌患者预后的价值[J/OL]. 中华肝脏外科手术学电子杂志, 2020, 09(06): 533-537.

Xujian Huang, Facai Yang, Meng Li, Xiaopeng Liu, Taian Chen, Yi He, Qiang Li, Jian Xu, Gang Yang, Changkang Wu, Yongfu Xiong, Jingdong Li. Prognostic value of hepatectomy combined with lymph node dissection in patients with intrahepatic cholangiocarcinoma and clinical negative lymph node metastasis[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2020, 09(06): 533-537.

目的

探讨肝切除联合淋巴结清扫对临床淋巴结阴性的肝内胆管癌（ICC）患者预后的价值。

方法

回顾性分析2010年1月至2018年2月川北医学院附属医院行根治性手术切除的142例临床淋巴结阴性ICC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77例，女65例；年龄23～78岁，中位年龄57岁。根据术中是否行淋巴结清扫分为淋巴结清扫组（LND组，86例）和非淋巴结清扫组（NLND组，56例），LND组根据术后病理提示进一步分为有淋巴结转移组（N1组，38例）和无淋巴结转移（N0组，48例），分析淋巴结清扫对ICC患者预后的影响。生存分析采用Kaplan-Meier法和Log-rank检验。

结果

NLND、LND组行半肝切除和（或）尾状叶及肝外胆管切除分别为20、71例，LND组切除范围更大（χ²=29.233，P<0.05）。LND组术后平均住院时间为（19±10）d，明显长于NLND组的（16±5）d（t=3.961，P<0.05）。LND组1、3、5年累积生存率分别为82%、42%、20%，NLND组相应为89%、47%、34%，两组总体生存差异无统计学意义（χ²=0.846，P>0.05）。N1组1、3、5年累积生存率为63%、14%、0，N0组相应为93%、57%、28%。NLND组与N1组比较差异有统计学意义（χ²=9.525，P<0.05），而NLND组与N0组比较差异无统计学意义（χ²=0.300，P>0.05）。

结论

淋巴结清扫对临床淋巴结阴性ICC患者预后无明显改善，且增加了住院时间，应慎重考虑常规施行淋巴结清扫。

关键词: 胆管肿瘤, 肝切除术, 淋巴结切除术, 预后

Objective

To evaluate the prognostic value of hepatectomy combined with lymph node dissection (LND) in intrahepatic cholangiocarcinoma (ICC) patients with clinical negative lymph node metastasis.

Methods

Clinical data of 142 ICC patients with negative lymph node metastasis who underwent radical resection in the Affiliated Hospital of North Sichuan Medical College from January 2010 to February 2018 were retrospectively analyzed. The informed consents of the patients were obtained and the local ethical committee approval was received. Among them, 77 patients were male and 65 female, aged 23-78 years witha median age of 57 years. According to whether LND was performed during operation, all patients were divided into the LND group (n=86) and non-LND (NLND) group (n=56). Patients in LND group were further divided into the lymph node metastasis (N1) group (n=38) and non-lymph node metastasis (N0) group (n=48) according to postoperative pathological findings. The effect of LND upon the prognosis of ICC patients was evaluated. Survival analysis was performed by Kaplan-Meier survival curve and Log-rank test.

Results

In NLND and LND groups, 20, 71 cases underwent hemihepatectomy and/or resection of caudate lobe, extrahepatic bile duct, respectively. The resection range in LND group was significantly larger than that in NLND group (χ2=29.233, P<0.05). The mean length of postoperative hospital stay in LND group was (19±10) d, significantly longer than (16±5) d in NLND group (t=3.961, P<0.05). The 1-, 3- and 5-year cumulative survival rates in LND group were 82%, 42% and 20%, which did not significantly differ from 89%, 47% and 34% in NLND group (χ2=0.846, P>0.05). In N1 group, the 1-, 3-, and 5-year cumulative survival rates were 63%, 14% and 0, and were 93%, 57% and 28% in N0 group.Significant difference was observed between the NLND and N1 groups (χ2=9.525, P<0.05), whereas no significant difference was observed between the NLND and N0 groups (χ2=0.300, P>0.05).

Conclusions

LND does not improve the clinical prognosis of ICC patients with clinical negative lymph nodes metastasis, whereas it increases the length of hospital stay. Routine LND should be performed with discretion.

Key words: Bile duct neoplasms, Hepatectomy, Lymph node excision, Prognosis

表1 NLND组与LND组肝内胆管癌患者临床病理特征比较

分组	例数	性别（例）		年龄（岁，±s）	TB[mmol/L，M(R)]	ALB（mmol/L，±s）	ALT[mmol/L，M(R)]	CA19-9[kU/L，M(R)]	乙肝		肝内胆管结石		肿瘤直径（cm，±s）
分组	例数	男	女	年龄（岁，±s）	TB[mmol/L，M(R)]	ALB（mmol/L，±s）	ALT[mmol/L，M(R)]	CA19-9[kU/L，M(R)]	阴性	阳性	无	有	肿瘤直径（cm，±s）
NLND组	56	39	17	54±11	14(173)	43±4	25(413)	081(976)	36	20	49	7	5.3±2.1
LND组	86	38	48	56±11	12(239)	42±4	18(453)	112(999)	65	21	72	14	6.3±2.8
统计值		χ²=8.855		t=-0.002	Z=1.330	t=0.023	Z=1.844	Z=-0.918	χ²=2.107		χ²=0.384		t=-2.693
P值		0.003		0.967	0.184	0.881	0.065	0.358	0.185		0.633		0.103
分组	例数	肿瘤数目		肿瘤位置					TNM分期
分组	例数	单发	多发	左肝	右肝	尾状叶	中肝	双侧肝脏	ⅠA	ⅠB	Ⅱ	Ⅲ
NLND组	56	41	15	18	27	1	7	3	20	14	14	8
LND组	86	59	27	46	26	1	10	3	14	21	9	42
统计值		χ²=0.346		χ²=6.672					χ²=24.382
P值		0.579		0.149					<0.001
分组	例数	淋巴结		组织学分化（例）			血管侵犯（例）		神经侵犯（例）		其他侵犯（例）		癌栓（例）
分组	例数	阴性	阳性	高分化	中分化	低分化	无	有	无	有	无	有	无	有
NLND组	56	-	-	0	48	8	55	1	53	3	53	3	50	6
LND组	86	48	38	1	80	5	77	9	76	10	81	5	75	11
统计值		-		-			χ²=3.903		χ²=1.604		χ²=0.357		χ²=0.139
P值		-		0.173			0.089		0.247		0.741		0.796

表1 NLND组与LND组肝内胆管癌患者临床病理特征比较

分组	例数	性别（例）		年龄（岁，±s）	TB[mmol/L，M(R)]	ALB（mmol/L，±s）	ALT[mmol/L，M(R)]	CA19-9[kU/L，M(R)]	乙肝		肝内胆管结石		肿瘤直径（cm，±s）
分组	例数	男	女	年龄（岁，±s）	TB[mmol/L，M(R)]	ALB（mmol/L，±s）	ALT[mmol/L，M(R)]	CA19-9[kU/L，M(R)]	阴性	阳性	无	有	肿瘤直径（cm，±s）
NLND组	56	39	17	54±11	14(173)	43±4	25(413)	081(976)	36	20	49	7	5.3±2.1
LND组	86	38	48	56±11	12(239)	42±4	18(453)	112(999)	65	21	72	14	6.3±2.8
统计值		χ²=8.855		t=-0.002	Z=1.330	t=0.023	Z=1.844	Z=-0.918	χ²=2.107		χ²=0.384		t=-2.693
P值		0.003		0.967	0.184	0.881	0.065	0.358	0.185		0.633		0.103
分组	例数	肿瘤数目		肿瘤位置					TNM分期
分组	例数	单发	多发	左肝	右肝	尾状叶	中肝	双侧肝脏	ⅠA	ⅠB	Ⅱ	Ⅲ
NLND组	56	41	15	18	27	1	7	3	20	14	14	8
LND组	86	59	27	46	26	1	10	3	14	21	9	42
统计值		χ²=0.346		χ²=6.672					χ²=24.382
P值		0.579		0.149					<0.001
分组	例数	淋巴结		组织学分化（例）			血管侵犯（例）		神经侵犯（例）		其他侵犯（例）		癌栓（例）
分组	例数	阴性	阳性	高分化	中分化	低分化	无	有	无	有	无	有	无	有
NLND组	56	-	-	0	48	8	55	1	53	3	53	3	50	6
LND组	86	48	38	1	80	5	77	9	76	10	81	5	75	11
统计值		-		-			χ²=3.903		χ²=1.604		χ²=0.357		χ²=0.139
P值		-		0.173			0.089		0.247		0.741		0.796

图1 临床淋巴结阴性肝内胆管癌患者根治性手术切除术后Kaplan-Meier生存曲线

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Prognostic value of hepatectomy combined with lymph node dissection in patients with intrahepatic cholangiocarcinoma and clinical negative lymph node metastasis

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Prognostic value of hepatectomy combined with lymph node dissection in patients with intrahepatic cholangiocarcinoma and clinical negative lymph node metastasis