联合肝叶切除的肝门部胆管癌RO级根治术明显延长患者生存期

摘要

目的:本文通过分析单个医学中心5年期间所实施的肝门部胆管癌手术治疗病例资料,确定影响患者术后生存的因素.方法:收集并分析西安交通大学医学院第一附属医院肝胆外科2003-2007年实施102例肝门部胆管癌根治术患者的临床资料,通过统计学方法分析影响患者术后生存期的因素.结果:25例(24.5％)患者入院时丧失接受根治性手术机会,仅行PTBD减黄治疗.77例患者接受开腹手术治疗,67例(87.0％)患者接受根治性切除,其中51例(76.1％)患者术后证实达到R0级.接受开腹手术患者术后1月的并发症发生率为20.8％,术后1月无患者死亡.单因素分析发现联合肝叶切除的根治术、R0级根治术、较好的肿瘤分化程度、肿瘤大小和未发生淋巴结肿瘤转移均影响患者术后的生存期.多因素分析证实联合肝叶切除的根治术和R0级根治术是影响患者术后生存的独立因素.结论:达到R0级的联合肝叶切除的肝门部胆管癌根治术明显延长患者术后生存期,可考虑成为肝门部胆管癌外科治疗的金标准.%Objective:Surgery has been considered as the only potential curative treatment for hilar carcinoma.Due to the complicated hilar structure,it is challenging for surgeon to perform radical resection without a golden standard.To investigate the factors contributing to the post-surgical survival of patients with hilar cholangiocarcinoma,we analyzed the clinical data of patients with hilar changiocarcinoma receiving surgical treatment in a single medical center during a 5-year period.Methods:The clinical data of 102 hilar changiocarcinomas admitted in Department of Hepatobiliary Surgery,the First Affiliated Hospital,School of Medicine,Xian Jiaotong Univeristy from 2003-2007 were collected and anaylzed retrospectively to find out the factors influencing surgical outcome.Results:Twenty five (24.5％) patients had unresectable diseases at present and only received PTBD treatment.Among 77 cases undergoing laparotomy,67 patients(87.0％) were given radical surgery and the R0 curative resection rate was 76.1％.Among the patients who underwent laparotomy,the operative morbidity (one month after operation) were 20.8％ and no patients died preoperatively.Univariate analysis revealed that factors predictive of improved prognosis included radical hilar changiocarcinoma resection with hepatic lobectomy,R0 curative resection,tumor size,well tumor differention and lack of lymph node metastasis.Both hilar changiocarcinoma resection with hepatic lobectomy and R0 curative resection were verified to be significantly associated with promosing survival dependently as analyzed by COX multivariate analysis.Conclusion:Hilar changiocarcinoma radical resection and concomitant hepatic lobectomy with microscopically tumor-free surgical margin can promote post-surgical outcome of hilar changiocarcinoma apparently and has the potential to be the golden standard of treatment for hilar changiocarcinoma.