【作者】 周健；

【导师】 罗放；

【作者基本信息】 重庆医科大学 ， 肝胆外科， 2010， 硕士

【摘要】 目的:探讨肝门胆管癌(Hepatic hilar cholangiocarcinoma/Klatskin tumor)的临床特征和治疗方法对患者生存率的影响及其切除术后的预后因素。方法:对2004年-2009年收治的61例肝门胆管癌患者的临床特点、诊断、手术方式和随访结果进行回顾性分析。选择对肝门胆管癌切除术后预后可能产生影响的临床因素,通过COX比例风险模型进行多因素预后分析。结果:61例手术治疗的肝门胆管癌,根治性切除30例,根治性切除附加尾状叶及肝叶切除10例,姑息性切除8例,置管引流13例。61例患者总体1、2、3年生存率分别为73.8%、62.3%、36.1%。手术切除组和置管引流组生存率差异有统计学意义(P<0.01),根治性切除组与姑息性切除组生存率差异有统计学意义(P<0.01),根治性切除组与根治性切除附加尾状叶及肝叶切除组生存率有统计学意义(P<0.05)。COX分析结果表明手术方式及肿瘤细胞分化程度是肝门胆管癌的根治切除影响预后的独立因素(P<0.05)。结论:(1)根治性切除可以提高HCC患者远期生存率。(2)根治性切除特别是附加肝叶切除及肝十二指肠韧带骨骼化清扫,可以延长复发时间,是提高根治切除率及远期疗效的关键。(3)胆管梗阻时间长,肝功能差及残肝功能不足是引起严重并发症的原因。(4)术后三维适型放疗可以提高生存率,但是远期结果尚待进一步总结。更多还原

【Abstract】 Objective:To explore the impact of clinical features and surgical procedure on survival of hepatic hilar cholangiocarcinoma(HCC)and the prognostic factors in patients with Klatskin tumor after curative resection.Methods:From 2004 to 2009,61 Klatskin tumor patients undergoing operations were included in this study.The clinical features,diagnosis,surgical procedure and follow up data were retrospectively analyzed.Factors influencing postoperative survival were analyzed using COX multiple stepwise regression mode1.Results:Of the 61 patients,30 underwent radical resection and 10 underwent radical resection plus liver leaf resection,8 underwent palliative resection,13 underwent drainage or laparotomy.The overall 1-,2-,and 3-year survival rates were 73.8%,62.3%,and 36.1%,respectively.COX analysis showed surgical approach and degree of tumor differentiation were independent prognostic factors after radical resection(P<0.05).Conclusion: (1)The radical resection is the key factor for increasing the long-term survival rate and improving the life qualities of Klatskin tumor patients(.2)Partial hepatectomy in combination with skeletonization may be helpful for increasing radical resection rate and long term efficacy.(3)Bile duct obstruction for a long time,poor liver function and remnant liver function are causes for serious complications.(4)Three-dimensional conformal radiation therapy after surgery can increase the survival rate type,but long-term results have yet to be further summed.更多还原