肝细胞癌合并胆管癌栓的临床分型以及手术方式对其预后的影响

摘要

目的：探讨临床分型以及手术方式的选择对肝细胞癌合并胆管癌栓远期预后的影响，以合理选择肝细胞癌合并胆管癌栓的治疗方案。方法对100例肝细胞癌合并胆管癌栓的临床治疗情况及预后情况进行分析。按照简化的Ueda分型方法分为Ⅰ、Ⅱ、Ⅲ型；按不同手术方式分成4组，比较各组临床分型及各组并发症、复发及生存期情况。结果Ⅰ、Ⅱ、Ⅲ型各组患者远期预后比较均无统计学意义（P＞0．05）。Ⅰ型、Ⅱ型、Ⅲ型患者1年生存率分别为93．33％、80．65％、71．79％；2年生存率分别为70．00％、54．84％、43．59％；累积3年生存率分别为53．33％、35．48％、28．21％。A、B、C、D 4组患者再手术率分别为2．27％、21．43％、21．05％、33．33％；1年生存率分别为90．91％、75．00％、84．21％、22．22％；2年生存率分别为77．27％、39．29％、47．37％、11．11％；3年生存率分别为59．09％、21．43％、31．58％、0。4种手术方式患者再手术率、复发率、总生存率比较差异显著，具有统计学意义，A组患者再手术率、复发率明显低于B、C、D组（P＜0．05），生存率明显高于B、C、D组（P＜0．05）。结论临床分型对肝细胞癌合并胆管癌栓患者的远期预后影响不大；手术方式对肝细胞癌合并胆管癌栓的预后有影响。%Objective To study the influence of clinical classification and operation method on long-term prognosis of hepatocellular carcinoma ( HCC) with cholangiocarcinoma bolt ,and chose a reasonable treatment for HCC with cholangiocarcino-ma bolt.Methods 100 cases of patients with HCC with cholangiocarcinoma bolt were divided into Ⅰ,Ⅱ,Ⅲtypes according to the simplified Ueda method,and according to different operation methods were divided into 4 groups,and clinical typing,complica-tions,recurrence and survival situation of patients were compared .Results The difference in long-term prognosis among Ⅰ,Ⅱ,Ⅲsubtypes had no statistical significance (P>0.05).1-year survival rates of patients in subtypeⅠ,subtypeⅡ,subtype Ⅲwere 93.33%,80.65%and 71.79%,respectively,and 2-year survival rates were 70.00%,54.84%and 70.00%,respectively,and 3-year survival rates were 53.33%,35.48%and 28.21%,respectively.The reoperation rates of patients in A ,B,C,D groups were 2.27%,21.43%,21.05%and 2.27%,respectively,there had significant statistically difference .1-year survival rates of 4 groups were 90.91%,75.00%,84.21% and 22.22%,respectively, 2-year survival rates were 77.27%,39.29%,47.37% and 11.11%,respectively,and 3-year survival rates was 59.09%,21.43%,31.58% and 59.09%,respectively.The reoperation rates,recurrence rates,and overall survival rates among 4 groups had significant statistically difference .The reoperation rate,re-currence rate of group A were significantly lower than group B ,group C and group D (P<0.05),while the survival rate of group A was significantly higher than group B,group C and group D (P<0.05).Conclusion Clinical classification for HCC with bile duct carcinoma bolts has little influence on long-term prognosis of patients;operation method has effect on the prognosis of HCC with bile duct carcinoma bolts .