肝门部胆管癌术后生存影响因素分析

发布时间：2018-03-31 16:21

  本文选题：肝门部胆管癌　切入点：根治切除　出处：《浙江大学》2016年博士论文

【摘要】：目的：肝门部胆管癌是预后较差的恶性肿瘤,本研究旨在探讨肝门部胆管癌根治切除术后生存的影响因素。方法：回顾性分析2010年1月至2014年12月期间在浙江大学附属第一医院肝胆外科诊断为肝门部胆管癌并行根治切除手术的78例患者的生存情况,选择患者性别、年龄、术前总胆红素水平、术前CA19-9水平、Bismuth-Corlette分型、肿瘤大小、肿瘤分化程度、淋巴结转移、肝动脉侵犯、门静脉侵犯、肝实质侵犯、手术方式、门静脉切除重建以及术后化疗等潜在的预后影响因素进行单因素分析,再通过COX回归模型进行多因素分析。采用单变量模型探究转移淋巴结个数与比例对存在淋巴结转移患者预后的影响。结果：单因素分析显示术前总胆红素水平≥10mg/dl、肿瘤大小≥2.5cm、存在淋巴结转移、肝动脉侵犯、门静脉侵犯、肝实质侵犯的患者预后较差(P0.05)。多因素分析证实术前总胆红素水平(HR：2.515,P=0.002)、门静脉侵犯(HR：2.038,P=0.049)和淋巴结转移(HR：1.873,P=0.031)是影响肝门部胆管癌患者根治切除术后生存的独立因素。对于存在淋巴结转移的患者,转移淋巴结比例≥0.20提示预后较差(P=0.048)。结论：肝门部胆管癌的预后受术前总胆红素水平、肿瘤大小、淋巴结转移、肝动脉侵犯、门静脉侵犯、肝实质侵犯等多种因素的影响,其中术前总胆红素水平、门静脉侵犯、淋巴结转移是肝门部胆管癌患者根治切除术后生存的独立影响因素。对于存在淋巴结转移的患者,转移淋巴结比例0.20是评估预后的最佳截点。
[Abstract]:Objective: hilar cholangiocarcinoma is a malignant tumor with poor prognosis.Methods: from January 2010 to December 2014, 78 patients with hilar cholangiocarcinoma diagnosed by hepatobiliary surgery in the first affiliated Hospital of Zhejiang University were retrospectively analyzed.Preoperative total bilirubin level, preoperative CA19-9 level and Bismuth-Corlette classification, tumor size, tumor differentiation, lymph node metastasis, hepatic artery invasion, portal vein invasion, hepatic parenchyma invasion, operation mode,The potential prognostic factors such as portal vein resection and reconstruction and postoperative chemotherapy were analyzed by univariate analysis and multivariate analysis by COX regression model.Univariate model was used to investigate the influence of the number and proportion of metastatic lymph nodes on the prognosis of patients with lymph node metastasis.Results: univariate analysis showed that preoperative total bilirubin level 鈮，

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