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目的探讨肝门部胆管癌病人的预后因素。方法对中国人民解放军总医院肝胆外科1999~2004年手术治疗的98例肝门部胆管癌病人进行多因素Cox回归模型预后因素分析。结果建立了肝门部胆管癌术后生存危险状态函数。影响术后生存期的主要因素有肿瘤是否切除、手术方式、肿瘤组织病理分化程度、术前血清总胆红素值、肿瘤转移方式。切除术1,2,3年存活率分别为63·8%,29·1%,24·9%,引流术分别为36·0%,0,0,两者差异有统计学意义。结论手术切除肿瘤是治疗肝门部胆管癌病人的最佳方案,扩大淋巴结、受侵神经清扫有助于提高远期存活率,正确合理的围手术期处理是提高病人存活率的关键。
Objective To investigate the prognostic factors of patients with hilar cholangiocarcinoma. Methods The prognostic factors of multivariate Cox regression model in 98 patients with hilar cholangiocarcinoma who underwent surgery in the Department of Hepatobiliary Surgery, General Hospital of PLA, 1999-2004 were analyzed. Results The postoperative survival risk function of hilar cholangiocarcinoma was established. The main factors affecting postoperative survival were tumor resection, surgical approach, the degree of tumor histopathological differentiation, preoperative serum total bilirubin value, tumor metastasis. Survival rates at 1, 2 and 3 years after resection were 63.8%, 29.1% and 24.9%, respectively, and drainage rates were 36.0% and 0,0. The difference between the two groups was statistically significant. Conclusions Surgical resection of the tumor is the best treatment for patients with hilar cholangiocarcinoma. Expanding the lymph nodes and invasion of nerves can improve the long-term survival rate. Correct and appropriate perioperative management is the key to improve patient survival rate.