远端胆管癌行胰十二指肠切除术后复发危险因素分析

发布时间：2018-08-31 14:35

【摘要】：[目的]:探究和探讨远端胆管癌在行胰十二指肠切除术后肿瘤复发的危险因素,进一步为临床治疗提供参考。本课题将更为全面的从患者术前因素、手术因素、肿瘤病理因素、术后因素四方面的多个因素来研究分析影响远端胆管癌术后复发的危险因素。从而更好的评估胆总管远端癌行根治手术的预后,更好的为患者选择适合的手术或治疗方法,以保证患者生存质量。[方法]:回顾性分析2009年1月至2015年1月于昆明医科大学第二附属医院肝胆胰外科一病区诊断为胆总管远端癌,并行胰十二指肠根治性切除的73例患者的临床资料。以患者术后两年内是否复发为依据将患者分为复发组和未复发组,将两组进行对比研究,分析可能影响复发的因素。分类变量和连续变量分别采用独立样本的X2检验和t检验,筛选出与术后复发有关的危险因素。Logstic回归模型对所筛选出的危险因素进行多因素分析,从而确定影响远端胆管癌行行胰十二指肠切除术后复发的独立危险因素。[结果]:随访的73例患者中,围手术期死亡患者2例,死亡率为2. 7%。剩余71例患者中术后两年内复发21例,未复发50例,复发率为29. 5%。独立样本统计分析示:术前白蛋白(P=0. 036 )、术中输血(P=0. 032 )、胰腺侵犯(P=0. 032 )、淋巴结转移(P0.01)、淋巴结转移比(P0.01)、肿瘤分化情况(P=0.017)、TNM分期(P0. 01)是影响远端胆管癌患者行胰十二指肠切除术后肿瘤复发的危险因素。Logstic多因素回归模型分析示:术前白蛋白水平(0.005)、肿瘤分化情况(P=0. 007)是影响肿瘤术后复发的独立危险因素。[结论1 :远端胆管癌患者中,男性较女性多发。其病理类型以腺癌多见。术前白蛋白水平、术中输血、胰头转移、淋巴结转移、淋巴结转移比、肿瘤分化情况、肿瘤TNM分期是影响远端胆管癌患者行胰十二指肠切除术后肿瘤复发的相关因素。其中术前白蛋白水平和肿瘤分化情况是影响远端胆管癌胰十二指肠术后复发的独立危险因素
[Abstract]:Objective: to explore the risk factors of tumor recurrence after pancreaticoduodenectomy for distal cholangiocarcinoma. This study will analyze the risk factors affecting the recurrence of distal cholangiocarcinoma from four factors: preoperative factors, surgical factors, tumor pathological factors and postoperative factors. Thus better evaluation of the prognosis of distal choledochus cancer radical surgery, better choice of surgery or treatment for patients, in order to ensure the quality of life of patients. [methods] the clinical data of 73 patients with distal choledochal carcinoma diagnosed in the Department of Hepatobiliary and Pancreatic surgery of the second affiliated Hospital of Kunming Medical University from January 2009 to January 2015 were retrospectively analyzed. The patients were divided into recurrence group and non-recurrence group according to whether the patients recurred within two years after operation. The two groups were compared to analyze the factors that might affect the recurrence. The risk factors associated with postoperative recurrence were screened by X _ 2 test and t test of independent samples, respectively. The risk factors were analyzed by logistic regression model. To determine the risk factors for recurrence of distal cholangiocarcinoma after pancreaticoduodenectomy. [results]: of the 73 patients followed up, 2 died during the perioperative period, with a mortality rate of 2. 5%. Seven. Among the remaining 71 cases, 21 cases recurred within two years after operation, 50 cases did not relapse, the recurrence rate was 29.9%. Five. The statistical analysis of independent sample showed that preoperation albumin (P0. 0. , intraoperative blood transfusion (P0. 0. , pancreatic invasion (P < 0.01), pancreatic invasion (P < 0.05), pancreatic invasion (P < 0.05). Lymph node metastasis (P0.01), lymph node metastasis ratio (P0.01), tumor differentiation (P0. 017) and TNM stage (P0. 01). 01) was a risk factor for tumor recurrence after pancreaticoduodenectomy in patients with distal cholangiocarcinoma. Logistic multivariate regression analysis showed that: preoperative albumin level (0.005), tumor differentiation (P0. 0). 007) is an independent risk factor for tumor recurrence after operation. Conclusions 1: in patients with distal cholangiocarcinoma, males are more frequent than females. Adenocarcinoma is the most common pathological type. Preoperative albumin level, intraoperative blood transfusion, pancreatic head metastasis, lymph node metastasis, tumor differentiation and tumor TNM staging were related factors for tumor recurrence after pancreaticoduodenectomy in patients with distal cholangiocarcinoma. The preoperative albumin level and tumor differentiation were independent risk factors for the recurrence of distal cholangiocarcinoma after pancreaticoduodenectomy.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.8

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