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目的探讨肝门部胆管癌治疗方式及疗效。方法回顾性分析2000年6月至2010年5月北京航天中心医院收治的49例肝门部胆管癌手术病例资料。分为单纯切除组、小范围切肝组与大范围切肝组,对比各组的并发症发生率。对临床病理资料进行单因素与多因素分析,检验对生存率的影响。结果单纯切除组17例,小范围切肝组10例,大范围切肝组22例,各组并发症发生率依次为23.5%(4/17),30.0%(3/10)和72.7%(16/22),后者明显高于前两组(P<0.05)。1,3,5年总生存率分别为73.2%,41.4%和21.3%,中位生存期30个月。单因素分析显示手术方式、切缘癌残留、淋巴结转移、T分期对生存率有影响(P<0.05)。多因素分析显示淋巴结转移(RR=3.787,95%CI 0.069～25.912)和切缘癌残留(RR=2.447,95%CI 1.508～3.971)是影响肝门部胆管癌手术生存率的独立危险因素(P<0.05)。结论根据肿瘤T分期、淋巴结转移等因素选择适宜的手术方式,有望获得更大的近远期疗效。
Objective To investigate the treatment and efficacy of hilar cholangiocarcinoma. Methods The data of 49 cases of hilar cholangiocarcinoma admitted to Beijing Aerospace Center Hospital from June 2000 to May 2010 were retrospectively analyzed. Divided into simple resection group, a small range of hepatectomy group and a wide range of hepatectomy group, compared the incidence of complications in each group. The clinical and pathological data were analyzed by single factor and multivariate test to test the impact on survival rate. Results There were 17 cases in simple excision group, 10 cases in small area hepatectomy group and 22 cases in large area hepatectomy group. The complication rates in each group were 23.5% (4/17), 30.0% (3/10) and 72.7% 16/22), which was significantly higher than the first two groups (P <0.05). The overall survival rates at 1, 3 and 5 years were 73.2%, 41.4% and 21.3%, respectively. The median survival time was 30 months. Univariate analysis showed that surgical methods, residual margin cancer, lymph node metastasis, T stage affect the survival rate (P <0.05). Multivariate analysis showed that lymph node metastasis (RR = 3.787, 95% CI 0.069 ~ 25.912) and margin cancer (RR = 2.447, 95% CI 1.508 ~ 3.971) were independent risk factors influencing the surgical survival rate of hilar cholangiocarcinoma P <0.05). Conclusion According to the tumor T stage, lymph node metastasis and other factors to choose the appropriate surgical approach, is expected to obtain greater short-term efficacy.