117例肝门部胆管癌病人外科治疗及其预后分析

  本文关键词：117例肝门部胆管癌病人外科治疗及其预后分析，由笔耕文化传播整理发布。

        目的：对经外科治疗的117例肝门部胆管癌病人的预后进行分析，讨论影响其预后的因素。方法：选取1999年至2012年间山西医科大学第二附属医院和山西省肿瘤医院经外科治疗的117例肝门部胆管癌的病人的资料进行病例回顾分析。将性别、年龄、术前血总胆红素值、术前血白蛋白值、术前肿瘤标记物CA199、CA242及CEA的检测结果、手术方式、淋巴结转移、门静脉浸润、毕氏分型（Bismuth-Corletter分型）、组织学分型总计10个因素作为可能影响预后的变量，选用统计学中生存分析对各项变量进行分析。对生存率选用Maplan-Meier乘积极限法进行统计，单因素生存时间的比较选用log-rank检验。对于单因素分析有显著意义的变量，再用多因素分析。多因素分析采用Cox比例风险回归模型进行分析评价。结果：单因素分析结果：（1）按性别分组后比较，结果为男性与女性相比中位生存时间的差异无统计学意义（P＞0.05）。（2）年龄分组后比较，结果为≥60岁组与＜60岁组相比中位生存时间的差异无统计学意义（P＞0.05）。（3）术前血清总胆红素分组后比较，结果为≥170umol/L组与＜170umol/L组相比中位生存时间的差异无统计学意义（P＞0.05）。（4）术前血清白蛋白分组后比较，结果为≥35g/L组与＜35g/L组相比中位生存时间的差异无统计学意义（P＞0.05）。（5）肿瘤标记物分组后比较，CA199值＞35u/L组与≤35u/L组相比中位生存时间的差异无统计学意义（P＞0.05）；CA242值＞35u/L组与≤u/L35组相比中位生存时间的差异无统计学意义（P＞0.05）；CEA值＞5u/L组与≤5u/L组相比中位生存时间的差异无统计学意义（P＞0.05）。（6）手术方式分组比较，结果为根治组、姑息组、内引流组及外引流组的中位生存时间总体差异有统计学意义（P＜0.05）。组间比较结果示：根治组与其余3组分别比较，中位生存时间延长，差异均有统计学意义（P＜0.05）；姑息组分别与内、外引流组比较，中位生存时间延长，差异有统计学意义（P＜0.05）；内外引流组间比较，中位生存时间的差异无统计学意义（P＞0.05）。（7）毕氏分型分组比较，结果为Ⅰ型组、Ⅱ型组、Ⅲ型组、Ⅳ型组生存时间总体差异无统计学意义（P＞0.05）。（8）有无淋巴结转移比较，有淋巴结转移组较无淋巴结转移组中位生存时间缩短，差异有统计学意义（P＜0.05）。（9）肝门静脉有无浸润比较，，有门静脉浸润组较无门静脉浸润组中位生存时间缩短，差异有统计学意义（P＜0.05）。（10）组织学分型比较，结果为高分化腺癌组、中分化腺癌组、低分化腺癌组及粘液癌组的中位生存时间总体差异有统计学意义（P＜0.05）。组间比较结果示：高分化腺癌组较其余3组中位生存时间长，差异有统计学意义（P＜0.05）；中分化组与低分化组、粘液腺癌组比较，中位生存时间差异有统计学意义（P＜0.05）；低分化腺癌组、粘液腺癌组比较，中位生存时间的差异无统计学意义（P＞0.05）。多因素分析结果：进入Cox比例风险模型的有手术方式、有无淋巴结转移、组织学分型，即上述三个因素是影响HC预后的独立因素。在有无淋巴结转移与组织学类型不变的情形下，手术方式的相对危险度为0.125，相对危险度95%可信区间为（0.050,0.311），即手术方式为保护性因素；根治性手术治疗效果好于姑息性切除、内引流及外引流治疗者，非根治性切除手术治疗者的死亡风险是根治性手术治疗者8倍。在手术方式和组织学分型不变的情形下，有淋巴结转移的相对危险度为2.985，相对危险度95%可信区间为（1.508,5.910），淋巴结转移者死亡风险是无淋巴结转移者的2.98倍。在手术方式和淋巴结转移不变的情形下，组织学分型的相对危险度为2.992，相对危险度95%可信区间为（1.540，5.815），低分化程度者死亡风险是较其分化程度高者（中分化者和高分化者）的2.99倍。结论：1.手术方式、组织学类型（肿瘤分化程度）、是否淋巴结转移、是否门静脉浸润是影响肝门部胆管癌病人预后的关键性因素。2.根治性切除术较姑息性切除术及内外引流术预后好，更适合综合条件符合要求的肝门部胆管癌病人。组织分化程度越低预后越差。有淋巴结转移者预后较无淋巴结转移者差。

    Objective: To analyze the prognosis of117Hilar Cholangiocarcinama patients whounderwent the treatment of surgery, then discuss the factors that effect its prognosis.Method: This retrospective analysis is comprised by informations of117HC patientswho underwent the diagnosis and treatment of surgery from1999to2012in theaffiliated second hospital of shanxi medical university and the tumor hospital ofshanxi province. We choose the survival analysis in medical statistics to analyze allvariables, these variables cover gender, age, preoperative total bilirubin, preoperativealbumin, test results of preoperative tumor markers CA199CA242CEA, surgicalprocedures pattern, lymph node metastasis, portal vein invasion, Bismuth-corlettetype, and histological classification, which may influence the prognosis. TheKaplan-Meier product-limited method estimates the survival rate and the Log-ranktest method is used to contrast the survival times of all the single fact. The markedand significant variables in the Log-rank test is analyzed by the multiple-factoranalysis. The multiple-factor analysis employ the Cox proportional hazardregression model to analyze and assess.Result:Single factor analysis:1. The compare by grouping sex shows that the differences of the median survivaltime between male and female are not statistic significance(P＞0.05).2. The compare by grouping age shows that the differences of the median survivaltime between≥60years and＜60years are not statistic significance(P＞0.05).3. The compare by grouping total bilirubin shows that the differences of the median survival time between≥170umol/L and＜170umol/L are not statistic significance(P＞0.05).4. The compare by grouping preoperative albumin value shows that the differences ofthe median survival time between≥35g/L and＜35g/are not statistic significance(P＞0.05).5. The compare by grouping test results of preoperative tumor markers shows that thedifferences of the median survival time between CA199＞35u/L and≤35u/L are notstatistic significance(P＞0.05),CA242＞35u/L and≤35u/L are not statisticsignificance(P＞0.05),CEA＞5u/Land≤5u/L are not statistic significance(P＞0.05).6. The compare by grouping A(radical resection group), B(palliative resection group),C(internal drainage group), D(external drainage group) shows that the totaldifferences of the median survival time between them are statistic significance (P＜0.05); The radical resection group(A) is longer the median survival time than otherthree groups’and its difference is statistic significance (P＜0.05);The median survivaltime of palliative resection group is longer than the internal drainage group andexternal drainage group respectively and the difference is statistic significance (P＜0.05); In the compare between the internal drainage group and the external drainagegroup, the differences of the median survival time is not statistic significance (P＞0.05).7. The compare by grouping Bismuth-corlette type (BⅠ,BⅡ,BⅢ,BⅣ)shows that thedifferences of the median survival time between them are not statistic significance(P＞0.05).The compare by grouping lymph node metastasis and not one shows that thedifferences of the median survival time between lymph node metastasis group and notlymph node metastasis group are statistic significance(P＜0.05).8. The compare by grouping lymph node metastasis and not one shows that the differences of the median survival time between lymph node metastasis group and notlymph node metastasis group are statistic significance(P＜0.05).9. The compare by grouping portal vein invasion and not one shows that thedifferences of the median survival time between portal vein invasion group and notportal vein invasion group are statistic significance(P＜0.05).10. The compare by grouping the histological classification including A(high or welldifferentiated adenocarcinoma group), B(moderately differentiated adenocarcinomagroup), C(poorly differentiated adenocarcinoma group), D(mucinous adenocarcinomagroup) shows that the total differences of the median survival time between them arestatistic significance(P＜0.05); The well differentiated adenocarcinoma group(A) islongest the median survival time than other three groups’ and its difference is statisticsignificance(P＜0.05);The median survival time of moderately differentiatedadenocarcinoma group(B) is longer than the other two groups respectively and thedifference is statistic significance (P＜0.05); In the compare between the poorlydifferentiated adenocarcinoma group and the mucinous adenocarcinoma group, thedifferences of the median survival time is not statistic significance (P＞0.05).Multiple-factor analysis:There are some independent factors to enter into the Cox proportional hazardregression model that includes the surgical approach, the lymph node metastasis andthe histological classification. They are the independent factors which could effect theprognosis of HC. If two facts about the lymph node metastasis and the histologicalclassification were constant, RR(the relative risk) of the surgical approach would be0.125,95%CI(confidence interval) for RR would be (1.540,5.815). It means that thesurgical approach is a protective factor. The efficacy of the radical resection group isbetter than the others including the alliative resection group, the internal drainagegroup and the external drainage group. The mortality risk of patient who accepts the no radical resection treatment are8times greater than one of patient who accepts theradical resection treatment. If two facts about the surgical approach and thehistological classification were constant, RR of the lymph node metastasis would be2.985,95%CI for RR would be （1.508,5.910）. It means that the mortality risk ofpatient who has the lymph node metastasis are2.5times greater than the one who hasnot the lymph node metastasis. If two facts about the surgical approach and the lymphnode metastasis were constant, RR of the histological classification would be2.992,95%CI for RR would be （1.540,5.815）. It means that the mortality risk of patientwho has the poorly differentiated adenocarcinoma are2.99times greater than the onewho has not the poorly differentiated adenocarcinoma including the mucinousadenocarcinoma and the high or well differentiated adenocarcinoma.Conclusion:1. The surgical procedures pattern, histological classification, lymphnode metastasis, and portal vein invasion in HC patient are the important factors ofinfluencing hilar cholangiocarcinoma patient’s prognosis;2. The prognosis of radicalresection is better than the others about palliative resection, internal drainage, andexternal drainage group, so it is preference to the adequate synthetical evaluationhilar cholangiocarcinoma patient

117例肝门部胆管癌病人外科治疗及其预后分析

摘要5-8Abstract8-11前言12-14资料与方法14-17结果17-19讨论19-26结论26-27参考文献27-30附录30-33综述33-42    参考文献39-42攻读学位期间发表文献况42-43致谢43-45个人简历45

  本文关键词：117例肝门部胆管癌病人外科治疗及其预后分析，由笔耕文化传播整理发布。