联合肝叶切除治疗肝门部胆管癌的疗效分析

doi:10.3969/j.issn.1007-3969.2014.06.009

中国癌症杂志 ›› 2014, Vol. 24 ›› Issue (6): 451-456.doi: 10.3969/j.issn.1007-3969.2014.06.009

联合肝叶切除治疗肝门部胆管癌的疗效分析

彭沙沙¹,黄汉飞¹,段键¹,林杰¹,代敏¹,张艺²,曾仲¹

1.昆明医科大学第一附属医院器官移植中心，云南昆明 650032；
2.昆明医科大学护理学院，云南昆明 650031

出版日期:2014-06-30 发布日期:2014-07-29
通信作者: 曾仲　E-mail:zzong@medmail.com.cn
基金资助:
云南省卫生科技计划项目(No：2012ws0019)；云南省教育厅科学研究基金项目(No：2013C245)

Clinical efficacy of combined hemihepatectomy for hilar cholangiocarcinoma

PENG Sha-sha¹, HUANG Han-fei¹, DUAN Jian¹, LIN Jie¹, DAI Min¹, ZHANG Yi², ZENG Zhong¹

1.Organ Transplantation Center, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan 650032, China;
2.College of Nursing, Kunming Medical University, Kunming Yunnan 650031, China

Published:2014-06-30 Online:2014-07-29
Contact: ZENG Zhong E-mail: zzong@medmail.com.cn

摘要/Abstract

摘要：

背景与目的：肝门部胆管癌(hilar cholangiocarcinoma，HC)侵袭途径广泛以及术后缺乏有效辅助治疗，目前患者获得治愈的惟一途径依然是手术根治性切除。术前可切除性评估、术前胆道引流、肝切除的范围及淋巴结清扫范围等问题一直是研究的热点。本文探讨联合肝叶切除治疗HC的临床经验及疗效。方法：回顾性分析昆明医科大学第一附属医院2007年1月—2013年10月行手术治疗的207例HC患者的临床及随访资料。结果：全组207例患者中，125例行根治性切除(R₀切除)，R₀切除率为60.4%。联合肝叶切除156例，肝叶切除组获R0切除率70.5%；51例行单纯性切除，单纯性切除组获R₀切除率29.4%，两组比较R₀切除率差异有统计学意义(P<0.01)。2例患者死于围手术期，术后主要并发症包括肝肾功能不全和胆漏。获得随访的172例中，102例行R₀切除的患者中位生存时间为45个月，术后1、3、5年累积生存率分别为96.1%、59.1%、17.2%，70例行R_1-2切除的患者中位生存时间为26个月，术后1、3年累积生存率分别为81.3%、19.2%，无5年存活患者。获得R₀切除患者术后生存率优于姑息性切除(R_1-2切除)患者，差异有统计学意义(χ²=39.121，P<0.01)。在联合肝叶切除组中获R₀切除患者术后1、3、5年生存率为97.8%、63.9%、18.0%，在单纯性切除组中获R₀切除患者术后1、3、5年生存率为83.3%、20.8%、8.3%，两组术后生存率差异有统计学意义(χ²=5.988，P=0.014)。结论：根治性切除是提高HC远期疗效的关键，联合肝叶切除及标准化淋巴结清扫可显著提高HC的根治性切除率及远期疗效。

关键词: 胆管肿瘤, 肝门部, 肝叶切除, 疗效

Abstract:

Background and purpose: Because of the aggressive nature of hilar cholangiocarcinoma and the absence of effective adjuvant therapy, surgical radical resection offers hilar cholangiocarcinoma patients the only choice. Research focus include preoperative assessment, the use of preoperative biliary drainage, the range of hepatic resection, and the range of lymphadenectomy. To investigate the clinical experience and efficacy of combined hepatectomy in the treatment of hilar cholangiocarcinoma. Methods: Two hundred and seven patients with hilar cholangiocarcinoma treated surgically in the First Affiliated Hospital of Kunming Medical University form Jan. 2007 to Oct. 2013 were retrospectively analyzed. Results: Of the 207 patients, 125 patients who received radical resection (R₀ resection) and the curative resection rate was 60.4%. One hundred and fifty-six cases were treated in combined hepatectomy group, 51 cases in non-hepatectomy group, the rate of R₀ resection was 70.5% in hepatectomy group and 29.4% in non-hepatectomy group, and the difference was significant (P<0.01). Two patients died perioperatively, the main postoperative complications included hepatic function insufficiency and bile leakage. One hundred and seventy- two patients were followed up, the median survival time of the 102 patients who received R₀ resection was 45 months, and the 1, 3, 5 year survival rates were 96.1%, 59.1% and 17.2%. The median survival time of the 70 patients who received R_1-2 resection was 26 months, and the 1, 3 year survival rates were 81.3% and 19.2%, and none of the patient survived for over 5 years. The survival rate of patients who received R0 resection was significantly higher than those who received R1-2 resection (χ²=39.121, P<0.01). In the hepatectomy group was awarded the R₀ resection in patients with postoperative 1, 3, 5 year survival rate was 97.8%, 63.9% and 18.0%, in non-hepatectomy group received R₀ resection in patients with postoperative 1, 3, 5 year survival rate was 83.3%, 20.8% and 8.3%. There were significant differences in the postoperative survival rate between both group (χ²=5.988, P=0.014). Conclusion: Radical excision is the key to improve the long term survival. Combined hemihepatectomy and standardized lymph node resection has significantly improved the radical resection rate and the efficacy of treatment for hilar cholangiocarcinoma.

Key words: Biliary neoplasms, Hilar, Hepatectomy, Efficacy

彭沙沙,黄汉飞,段键,林杰,代敏,张艺,曾仲. 联合肝叶切除治疗肝门部胆管癌的疗效分析[J]. 中国癌症杂志, 2014, 24(6): 451-456.

PENG Sha-sha, HUANG Han-fei, DUAN Jian, LIN Jie, DAI Min, ZHANG Yi, ZENG Zhong. Clinical efficacy of combined hemihepatectomy for hilar cholangiocarcinoma[J]. China Oncology, 2014, 24(6): 451-456.

[1]	陆　立, 卢仁泉, 孙佳俊, 陆　凝, 郭　林. 血清N-MID在原发性肺癌患者骨转移辅助诊断和疗效监测中的应用分析[J]. 中国癌症杂志, 2021, 31(9): 838-844.
[2]	义维丽, 赵文成, 黄东宁, 覃　莉, 吴新天, 周　斐, 吴凤英 . PD-1单抗治疗非小细胞肺癌相关不良反应及其与疗效的相关性分析[J]. 中国癌症杂志, 2021, 31(3): 203-211.
[3]	武鸿文, 梅　艳, 王　乔, 袁　佳, 赵立威. 血清MIP-1α、S-TK1对于甲状腺癌术后放射性 ¹³¹ I治疗效果评估的临床价值[J]. 中国癌症杂志, 2021, 31(11): 1088-1095.
[4]	胡　磊, 董红军, 徐　浩, 袁毅方, 王耀华 . 喉部分切除术和经口内镜CO ₂ 激光显微手术治疗前联合阳性早期声门癌患者的疗效比较[J]. 中国癌症杂志, 2020, 30(2): 142-147.
[5]	孙健达，熊俊，张汉雄，陈意标. 血液标志物在局部晚期鼻咽癌中的预测价值[J]. 中国癌症杂志, 2019, 29(7): 528-534.
[6]	高志强,王韡旻,蔡雨晴,秦若琰,顾爱琴,熊丽纹,韩宝惠,姜丽岩,施春雷 . 奥希替尼治疗62例晚期肺腺癌患者的临床疗效观察[J]. 中国癌症杂志, 2019, 29(10): 809-814.
[7]	孙佳俊,卢仁泉,郑　慧,等. 血清HER2-ECD水平在乳腺癌新辅助化疗中的应用价值分析[J]. 中国癌症杂志, 2019, 29(1): 32-36.
[8]	杨佑琦,区晓敏,周　鑫,等. GP、PF及TPF方案化疗联合调强适形放疗治疗鼻咽癌的临床疗效[J]. 中国癌症杂志, 2018, 28(8): 602-608.
[9]	张迎强,张　鑫,王　宸,等. ¹⁸F-FDG PET/CT在阿帕替尼治疗肺多发转移性碘难治性分化型甲状腺癌评估中的价值[J]. 中国癌症杂志, 2018, 28(7): 505-510.
[10]	张腾,胡厚洋,柏庆花,等. 慢性淋巴细胞性甲状腺炎对分化型甲状腺癌放射性碘清甲治疗效果的影响[J]. 中国癌症杂志, 2018, 28(6): 419-423.
[11]	周　迪,刘苓霜,姜　怡,等. 中医药联合甲磺酸阿帕替尼治疗Ⅳ期恶性肿瘤的单臂单中心临床研究[J]. 中国癌症杂志, 2018, 28(11): 833-839.
[12]	张　娜,梁　军,林岩松. 甲状腺球蛋白抗体对甲状腺乳头状癌¹³¹I清甲疗效的影响[J]. 中国癌症杂志, 2017, 27(6): 476-481.
[13]	胡厚洋,梁　军,张　腾,等. 分化型甲状腺癌被膜及被膜外微小侵犯与复发风险[J]. 中国癌症杂志, 2017, 27(12): 946-952.
[14]	李高翔,戴　波,叶定伟,等. 寡转移性前列腺癌根治术的临床初步疗效观察及围手术期并发症分析[J]. 中国癌症杂志, 2017, 27(1): 20-25.
[15]	李瑞敏,顾雅佳,彭卫军,等. 定量动态增强磁共振评估乳腺癌新辅助化疗疗效的应用研究[J]. 中国癌症杂志, 2016, 26(7): 623-628.

联合肝叶切除治疗肝门部胆管癌的疗效分析

Clinical efficacy of combined hemihepatectomy for hilar cholangiocarcinoma

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价