肝门部胆管癌根治术后复发高危因素的临床研究

发布时间：2018-09-12 17:55

【摘要】：目的:探讨影响患者接受根治性切除术后复发高危因素,帮助临床医师科学、全面评估患者预后,以便完善治疗策略,更好地改善患者预后。方法:采用回顾性分析方法,收集宁夏医科大学总医院及宁夏人民医院肝胆外科2000年1月至2015年12月接受肝门部胆管癌根治性切除手术患者的完整病例及随访资料72例,通过非条件Logistic回归模型,选择年龄、性别、术前是否合并胆道结石、术前总胆红素及术前CA19-9水平、Bismuth-Corlette分型、术中出血量与输血量、肿瘤大小、分化程度、淋巴结转移及神经浸润等12个研究指标,分析其对患者接受根治术后1年内复发的影响。结果:72例接受根治性切除手术的患者中,26例术后1年内复发,复发率为36.1%,通过Logistic回归模型多因素分析显示,术前总胆红素水平(OR=4.488,95%CI=1.058~19.031)、术前CA19-9水平(OR=5.944,95%CI=1.491~23.693)、Bismuth-Corlette分型(OR=4.494,95%CI=1.254~16.110)、淋巴结转移(OR=4.143,95%CI=1.134~15.140)及神经浸润(OR=5.343,95%CI=1.101~25.920)是影响肝门部胆管癌患者接受根治性切除手术后复发的高危因素。结论:肝门部胆管癌患者接受根治性切除手术后复发是影响其总体预后的重要原因;具体高危因素为术前总胆红素及CA19-9水平、Bismuth-Corlette分型、伴有淋巴结转移及神经浸润,在评估肝门部胆管癌患者预后方面有临床指导意义。
[Abstract]:Objective: to explore the risk factors of recurrence after radical resection, to help clinicians to evaluate the prognosis of patients and to improve the prognosis of patients. Methods: the complete cases and follow-up data of 72 patients undergoing radical resection of hilar cholangiocarcinoma in the General Hospital of Ningxia Medical University and the Department of Hepatobiliary surgery in Ningxia people's Hospital from January 2000 to December 2015 were retrospectively analyzed. Age, sex, preoperative total bilirubin and preoperative CA19-9 level were determined by non conditional Logistic regression model. Blood loss and blood transfusion volume, tumor size and differentiation degree were determined. The influence of lymph node metastasis and nerve infiltration on recurrence within 1 year after radical operation was analyzed. Results among the 72 cases undergoing radical resection, 26 cases recurred within one year after operation, and the recurrence rate was 36.1%. The multivariate analysis of Logistic regression model showed that, Preoperative total bilirubin level (OR=4.488,95%CI=1.058~19.031), preoperative CA19-9 level (OR=5.944,95%CI=1.491~23.693) Bismuth-Corlette classification (OR=4.494,95%CI=1.254~16.110), lymph node metastasis (OR=4.143,95%CI=1.134~15.140) and nerve invasion (OR=5.343,95%CI=1.101~25.920) were high risk factors for recurrence of hilar cholangiocarcinoma after radical resection. Conclusion: recurrence after radical resection of hilar cholangiocarcinoma is an important factor affecting the overall prognosis, and the specific high risk factors are preoperative total bilirubin and CA19-9 level Bismuth-Corlette classification with lymph node metastasis and nerve invasion. It has clinical significance in evaluating the prognosis of hilar cholangiocarcinoma.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.8

【参考文献】