肝门部胆管癌姑息治疗的效果及预后分析:附218例报告

发布时间：2018-05-07 04:36

本文选题：Klatskin肿瘤 + 姑息疗法　；参考：《中国普通外科杂志》2017年08期

【摘要】：目的:探讨肝门部胆管癌姑息治疗的临床效果及预后。方法:回顾性分析2005年12月—2015年11月中南大学湘雅医院收治的218例肝门部胆管癌患者的临床及病理资料。结果:218例患者中,159例行姑息性手术(72.9%),包括胆道外引流术134例,胆肠内引流术25例;59例行介入治疗(27.1%),包括经皮肝穿刺胆道引流术(PTBD)27例,内镜下胆道支架置入术(ERBD)32例。2例术后30d内死亡;姑息性手术与介入治疗患者术后总胆红素均明显下降(均P0.05)。202例获随访,随访期间196例死亡。全组患者的中位生存时间和1、3、5年生存率为7个月和29.9%、8.1%、2.3%,其中姑息性手术患者为7个月和33.8%、10.3%、2.9%;介入治疗患者为7个月和14.9%、0、0,两者差异有统计学意义(χ~2=5.328,P0.05)。胆道外引流患者与胆肠内引流患者间生存率及PTBD患者与ERBD患者生存率差异均无统计学意义(χ~2=0.673;χ~2=0.023,均P0.05)。结论:肝门部胆管癌姑息治疗的远期疗效不佳,姑息性手术与介入治疗均能有效减黄,姑息性手术患者生存率高于介入治疗;介入治疗的方法简单、对患者创伤小。
[Abstract]:Objective: to investigate the clinical effect and prognosis of palliative treatment for hilar cholangiocarcinoma. Methods: the clinical and pathological data of 218 patients with hilar cholangiocarcinoma treated in Xiangya Hospital of Central South University from December 2005 to November 2015 were retrospectively analyzed. Results among the 218 cases, 159 cases underwent palliative operation, including 134 cases of extrabiliary drainage, 59 cases of choledointestinal drainage (25 cases) underwent interventional therapy, including 27 cases of PTBDD, including percutaneous transhepatic biliary drainage. The total bilirubin of 32 patients with ERBDD was significantly decreased after palliative operation and interventional therapy (all P 0.05 and 202 cases were followed up, 196 cases died during the follow-up period), and 32 cases died within 30 days after endoscopic biliary stenting (P < 0.05), and the total bilirubin decreased significantly in patients undergoing palliative operation and interventional therapy (P < 0.05). The median survival time and 1-, 5-year survival rate of the patients were 7 months and 29. 9% respectively, including 7 months and 33. 8% in palliative operation patients and 10. 3% and 2. 9 months in patients with palliative operation, and 7 months and 14. 990% in patients with interventional therapy, respectively (蠂 2. 328, P 0. 05, P 0. 05, P < 0. 05). There was no significant difference in the survival rate between the patients with external biliary drainage and the patients with biliary and intestinal drainage and between the patients with PTBD and the patients with ERBD (蠂 2 / 0.673, 蠂 ~ (2 +) = 0.023, all P 0.05). Conclusion: palliative treatment of hilar cholangiocarcinoma has poor long-term curative effect, palliative operation and interventional therapy can effectively reduce yellow, the survival rate of patients undergoing palliative operation is higher than that of interventional therapy, the method of interventional therapy is simple and less traumatic to the patients.
【作者单位】：中南大学湘雅医院胆胰外科;
【基金】：湖南省自然科学基金资助项目(13JJ5009)
【分类号】：R735.8

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