肝门部胆管癌不同治疗方法疗效的临床研究

发布时间：2019-06-07 13:29

【摘要】：肝门部胆管癌(HCCA)因其特殊的解剖位置及多极侵袭性生物学行为,导致手术技术复杂,难度大,创伤大,预后差,成为肝胆外科的难治之症。尤其是对不能行根治性手术治疗的病人,治疗方案的选择尚无统一标准。目的:本研究旨在通过对比分析本中心收治的HCCA患者的各种治疗方法,尤其是不同姑息性疗法的临床效果,以期指导今后的HCCA的个体化治疗,为HCCA患者提供最佳的治疗方案。方法:统计并随访2004年1月至2014年12月间就诊于本中心的101例肝门胆管癌患者的临床资料,随访截止日期为2016年12月31日,根据不同治疗方法分为5组:1.根治性手术切除组22例;2.姑息性手术切除组24例;3.经皮经肝胆管穿刺引流术(percutaneous transhepatic biliary drainage,PTCD)治疗组26例,4.胆道支架组16例,5.开腹手术胆道外引流组13例。对比各组之间在改善生存时间、并发症、住院费用和生活质量上的差异。结果:各组患者在接受治疗后肝功均能够恢复良好,在肝功能改善方面疗效相当;在术后并发症方面PTCD或胆道支架较其他两组更容易出现胆道感染、胆道出血等并发症;而根治性治疗组和姑息性手术组的术后早期并发症以胆汁漏为主,均在充分引流后自行愈合;在远期生存率方面,根治性治疗组、姑息性手术组、PTCD治疗组、胆道支架组以及开腹手术外引流组1年生存率分别为95.5%、75.0%、23.1%、25.0%、和30.7%;2年生存率分别为:40.9%、16.7%、0、0、0;3年生存率各组均为0。根治性手术组与其他四组疗法治疗效果差异明显,有统计学意义(P0.05),姑息性切除术组与PTCD治疗组、胆道支架组、开腹手术外引流组比较效果较好,差异有统计学意义(P0.05),PTCD治疗组与胆道支架组以及开腹手术外引流组3组比较疗效相当,差异无统计学意义(P0.05)。结论:根治性肝门部胆管癌切除术是肝门部胆管癌最有效的治疗方法,姑息性切除术次之。PTCD或胆道支架植入术是不能行手术治疗患者的首选治疗方法。开腹胆道外引流术因创伤大、费用高、影响生活质量、且不能延长生存期不建议采用。
[Abstract]:Because of its special anatomical position and multipolar invasive biological behavior, (HCCA) of hilar bile duct carcinoma has become a difficult disease in hepatobiliary surgery because of its complex surgical technique, great trauma and poor prognosis. Especially for patients who can not be treated by radical surgery, there is no unified standard for the choice of treatment plan. Objective: the purpose of this study was to compare and analyze the clinical effects of various treatment methods, especially different palliative treatments, for HCCA patients treated in our center, in order to guide the individualized treatment of HCCA in the future and to provide the best treatment for HCCA patients. Methods: the clinical data of 101 patients with hilar bile duct carcinoma from January 2004 to December 2014 were statistically analyzed and followed up. The follow-up deadline was December 31, 2016. According to different treatment methods, the patients were divided into 5 groups: 1. 22 cases in radical resection group; 2. 24 cases in palliative resection group; 3. There were 26 cases (4. 5%) in the treatment group treated with percutaneous transhepatic bile duct puncture and drainage (percutaneous transhepatic biliary drainage,PTCD). There were 16 cases (5. 5%) in the bile duct stent group. There were 13 cases in the external drainage group after laparotomy. The differences in improving survival time, complications, hospitalization expenses and quality of life were compared among the three groups. Results: the liver function of each group recovered well after treatment, and the curative effect was the same in the improvement of liver function. PTCD or stent were more likely to have complications such as bile duct infection and hemorrhage than the other two groups. In the radical treatment group and palliative operation group, the early postoperative complications were mainly bile leakage, both of which healed themselves after full drainage. In terms of long-term survival rate, the 1-year survival rates of radical treatment group, palliative operation group, PTCD treatment group, bile duct stent group and external drainage group were 95.5%, 75.0%, 23.1%, 25.0% and 30.7%, respectively. The 2-year survival rate was 40.9%, 66.7%, 0, 0, 0, and the 3-year survival rate was 0. 0%, 0. 0%, 0. 0% and 0. 0% respectively. The therapeutic effect of radical operation group was significantly different from that of the other four groups (P 0.05). The effect of palliative resection group was better than that of PTCD treatment group, bile duct stent group and laparotomy external drainage group. The difference was statistically significant (P 0.05). The curative effect of), PTCD treatment group was similar to that of bile duct stent group and laparotomy external drainage group, but the difference was not statistically significant (P 0.05). Conclusion: radical resection of hilar bile duct carcinoma is the most effective treatment for hilar bile duct carcinoma, followed by palliative resection. PTCD or stent implantation is the first choice for patients who can not be treated surgically. External drainage of open bile duct is not recommended because of its great trauma and high cost, which affects the quality of life and can not prolong the survival time.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.8

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