肝门部胆管癌外科治疗后生存期的相关因素分析
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摘要
【目的】:比较不同治疗方法对肝门胆管癌预后的影响
【方法】:随访并回顾性研究我院2000年1月—2005年4月共108例肝门胆管癌病人,根治性切除R0标准为切缘镜下无癌,切缘镜下可见癌细胞定为R1切除,切缘肉眼肿瘤组织定为R2切除,开腹引流包括开腹T型管和姑息性胆肠吻合术,非开腹包括的PTBD和支架治疗。预后观察起始点为:开腹手术日期或单纯经皮经肝胆道引流日期。观察终点为:死亡日期或本研究最后随访时间(2007年12月)。统计处理采用spss13.0软件进行统计处理,并比较各种治疗方法与生存率的关系。
【结果】:2000/1—2005/4病人肝门胆管癌共108例,根治性切除率33.3%(36/108),非根治性切除率36.1%(39/108)(R1,R2)例,引流组中开腹引流14例,非开腹19例接受肿瘤切除的病人生存期明显长于引流组(P＜0.01),其中根治切除的病人有着更高的生存率(P＜0.01)。
【结论】:手术方式是肝门胆管癌最重要的预后因素,在开腹手术中,根治性切除(R0)的效果最佳,非根治性切除(R1,R2)的效果要优于单纯旁路手术。开腹引流术与非开腹引流生存期无明显差异。
【objetive】:compare the effect of therapeutics methods to prognosis of hilar cholangiocarcinoma.
【Method】:a retrospective clinical analysiswas performed on the clinical data from 108 patients with hilar cholangiocarcinoma from jan 2000 to apr 2005.the standard of radical excision is non-cancer with microscope at incised margin or it can be classified as R1.the standard of R2 is that the remain of tumor can be found with naked eyes.laparotomized drainage include T-type pipe drainage and chole- intestinal anastomosis,non-laparotomized drainage include PTBD and biliary endoprosthesisThe time to initiate follow-up is the date of surgery.the end point is date of death or the last date of investigationStatistics:dispose the data with spss13.0 to compare the all kinds of therapy to HCC.
【result】:108 patients with hilar cholangiocarcinoma surgically treated in our hospital from jan 2000 to may 2003.the rate of radical resection is 33.3%(36/108),the the rate of palliative resection is36.1%(39/108)(R1,R2) In the drainage group 14 patients undergoing laparotomized drainage and 19 patients undergoing non-laparotomized respectively.The survival of patients with resection was longer than that of drainage group. among of them the patients with radical resection possess higher survival rate
【Conclusion】:the method of therapy is the most important factor to prognosis.The effect of radical excision is best among laparotomized operation.The effect of palliative resection is better than that of simple by-pass operation.there is no obvious difference between the survival of laparotomized and non-laparotomized drainage
【方法】:随访并回顾性研究我院2000年1月—2005年4月共108例肝门胆管癌病人,根治性切除R0标准为切缘镜下无癌,切缘镜下可见癌细胞定为R1切除,切缘肉眼肿瘤组织定为R2切除,开腹引流包括开腹T型管和姑息性胆肠吻合术,非开腹包括的PTBD和支架治疗。预后观察起始点为:开腹手术日期或单纯经皮经肝胆道引流日期。观察终点为:死亡日期或本研究最后随访时间(2007年12月)。统计处理采用spss13.0软件进行统计处理,并比较各种治疗方法与生存率的关系。
【结果】:2000/1—2005/4病人肝门胆管癌共108例,根治性切除率33.3%(36/108),非根治性切除率36.1%(39/108)(R1,R2)例,引流组中开腹引流14例,非开腹19例接受肿瘤切除的病人生存期明显长于引流组(P＜0.01),其中根治切除的病人有着更高的生存率(P＜0.01)。
【结论】:手术方式是肝门胆管癌最重要的预后因素,在开腹手术中,根治性切除(R0)的效果最佳,非根治性切除(R1,R2)的效果要优于单纯旁路手术。开腹引流术与非开腹引流生存期无明显差异。
【objetive】:compare the effect of therapeutics methods to prognosis of hilar cholangiocarcinoma.
【Method】:a retrospective clinical analysiswas performed on the clinical data from 108 patients with hilar cholangiocarcinoma from jan 2000 to apr 2005.the standard of radical excision is non-cancer with microscope at incised margin or it can be classified as R1.the standard of R2 is that the remain of tumor can be found with naked eyes.laparotomized drainage include T-type pipe drainage and chole- intestinal anastomosis,non-laparotomized drainage include PTBD and biliary endoprosthesisThe time to initiate follow-up is the date of surgery.the end point is date of death or the last date of investigationStatistics:dispose the data with spss13.0 to compare the all kinds of therapy to HCC.
【result】:108 patients with hilar cholangiocarcinoma surgically treated in our hospital from jan 2000 to may 2003.the rate of radical resection is 33.3%(36/108),the the rate of palliative resection is36.1%(39/108)(R1,R2) In the drainage group 14 patients undergoing laparotomized drainage and 19 patients undergoing non-laparotomized respectively.The survival of patients with resection was longer than that of drainage group. among of them the patients with radical resection possess higher survival rate
【Conclusion】:the method of therapy is the most important factor to prognosis.The effect of radical excision is best among laparotomized operation.The effect of palliative resection is better than that of simple by-pass operation.there is no obvious difference between the survival of laparotomized and non-laparotomized drainage
引文
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9.周宁新.对肝门部胆管癌根治切除手术方式的改进体会[J].中国实用外科杂志,1999,19(10):592-594.
10.SHIMADA H,ENDO I,SUGITA M,et al.Hepatic resection combined with portal vein or hepatic artery reconstruction for advanced carcinoma of the hilar bile duct and gallbladder[J].World J Surg,2003,27(10):1137-1142.
11.Tabata M,Kakuuchi M,Takayama T,et al.Long - term survival and prognostic factors in the surgical treatment of mass - forming type cholangiocarcinoma[J].Surgery,2000,127(5):498-505.
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32.黄志强.肝门部胆管癌外科治疗面临的问题与出路[J].中华实验外科杂志,2004,21(7):773-775.
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3.李维华,黄志强,周宁新,等.肝门部胆管癌的临床与病理学观察[J].中华外科杂志,1993,31:536.
4.MEIMH,FENG JL,CHEN Q,et al.Progressive invasion ofhepatic artery:an inportant factor impactiong on postoperative prognosis of hilarcholangiocarcinoma[J].Journal of Hepatobiliary Surgery,1999,6(7):438- 441.Chinese
5.TOMPKINS RK.Hilarcholagiocarcinoma:Aggessive or conservative treatment? A personal ecperience[J].J Hep Bil Pancr Surg,1995,2:224.
6.[ENDO I,MASUNARI H,SUGITA M,et al.Indications for combined resection and reconstruction of the hepatic artery in bilary tract carcinoma[J].Nippon Geka Gakkai Zassshi,2001,102(11):820-825.
7.韩风,周进学,庞春.联合肝动脉切除在肝门部胆管癌根治术中的应刚[J].中国现代医学杂志,2007,17(11)1395-1397
8.LI HX,TANG CM,QINCH,et al.The strategies of combined liver and hilar vascular resection for hilarcholagiocarcinoma[J].Chineses Journal of General Surgery,2004,13(7):485-488.
9.周宁新.对肝门部胆管癌根治切除手术方式的改进体会[J].中国实用外科杂志,1999,19(10):592-594.
10.SHIMADA H,ENDO I,SUGITA M,et al.Hepatic resection combined with portal vein or hepatic artery reconstruction for advanced carcinoma of the hilar bile duct and gallbladder[J].World J Surg,2003,27(10):1137-1142.
11.Tabata M,Kakuuchi M,Takayama T,et al.Long - term survival and prognostic factors in the surgical treatment of mass - forming type cholangiocarcinoma[J].Surgery,2000,127(5):498-505.
12.Nimura Y,Kamiya J,Kondo S,et al.Aggressive preoperative management and extended surgery for hilar cholangiocarcinoma:Nagoya experience[J].J-Hepatobiliary-Pancreat-Surg,2000,7(2):155-162.
13.舒晓钢,王国斌,郑启昌。肝门部胆管癌扩大根治术中肝动脉重建九例分析[J].临床外科杂志 2004,12(7):430-431
14.Longmire WP,Mcart hur MS,BastounisEA,et al.Carcinoma of the ext rahepatic biliary tract.Ann Surg,1973,178:333-345.
15.李森.肠系膜上静脉“胰后干”和门静脉干测量及临床意义.肝胆胰脾外科杂志,1995,1:240-244.
16.王建立,李森,冯立民,等。联合门静脉切除的肝门部胆管癌根治切除术.中华肝胆外科杂志,2005,11(3)167-168
17.牛朝诗,韩卉,耿小平.下腔静脉与肝静脉的外科应用解剖[J].肝胆外科杂志,1996,4(1):36-39.
18.Sato TJ,Hiraj I,Murakami G,et al.Ananatomical study of short hepatic veins,with special reference to delineation of the caudate lobe for hanging maneuver of the fiver without the usual mobilization[J].J Hepatobiliary Pancreat Surg,2002,9(1):55-60.
19.严律南.肝脏外科[M].北京:人民卫生出版社,2002:968.
20.Hemming AW,Kim RD,Mekeel KL,et al.Portal vein resection for hilar cholangiocarcinoma[J].Am Surg,2006,72(7):599-604;discussion 604-605.
21.Tsao J I,Nimura Y.Kamiya J,et al.Management of hilar cholangiocarcinoma.Comparison of an American and a Japanese experience[J].Ann Surg,2002,232(2):166-174.
22.Nimura Y,Hagakama N Kamiya J,et al.Hepatic segmentectomy with caudate lobe resection for bile duct carcinoma of the hepatic hilus[J].World J Surg,1990,14(4):535-544.
23.Baer HU,Stain SC,Dennison AR,et al.Imp rovements in survival by aggressive resections of hilar cholangiocarcinoma[J].Ann Surg,1993,217(1):20-27.
24.Suzuki M,Takahashi T,Ouchi K,et al.The development and extension of hepatohilar bile duct carcinoma.A three-dimensional tumor mapping in the intrahepatic biliary tree visualized with the aid of a graphic computer system[J].Cancer,1989,64(3):658-666.
25.何振平,郑树国,董家鸿,等.肝门部胆管癌的外科治疗(附181例报告)[J].中华肝胆外科杂志,1999,5(6):368-372.
26.Kondo S,Hirano S,Ambo Y,et al.Forty consecutive resectionsof hilar cholangiocarcinoma with no postoperative mortality and no positive ductal margins:results of a prospective study[J].Ann Surg,2004,240(1):95-101.
27.Gazzaniga GM,Filauro M,Bagarolo C,et al.Surgery for hilarcholangiocarcinoma:an Italian experience[J].J Hepatoboliary Pancreat Surg,2000,7(2):122-127.
28.Sander D,Michael F,Oliver R,et al.The importance of complete excision of the caudate lobe in resection of hilar cholangiocarcinoma[J].HPB,2005,7:263-267.
29.姜洪池,陆朝阳.肝门部胆管癌联合尾状叶根治性切除[J].中国实刚外科杂志,2007,27(5),364-366。
30.William R,Jarnagin,Yuman Fong,eta.l.Staging,Resectability,and Outcome in 225 Patients with Hilar Cholangiocarcinoma[J].Ann Surg,2001,234(4):507-519.
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