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目的探讨肝外胆管癌(EHCC)的临床特征、治疗方法对远期生存率的影响,研究EHCC切除术后的预后因素。方法对1995年1月至2003年12月收治的107例EHCC的临床特点、诊断、手术方式和随访结果进行回顾分析。选择对EHCC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的预后分析。结果107例手术治疗的EHCC,根治性切除47例(其中单纯骨骼化切除7例,联合各类肝叶切除12例,联合门静脉切除重建3例,联合胰十二指肠切除25例),姑息性切除12例,内或外引流术45例,探查性手术3例。EHCC总体生存率1,3,5年生存率分别为58.2%、30.0%和13.1%。其中根治性切除1,3,5年生存率分别为72.4%、44.7%和22.7%;姑息性切除1,2,3年生存率分别为54.5%、27.3%和9.1%,无5年存活者。引流组1,2,3年生存率分别为32.1%、17.2%和8.6%,无4年存活者。根治性切除组、姑息性切除组、内或外引流组及非手术组生存率相比较,差异有统计学意义(log-rank test,χ2=15.67,P<0.001)。肿瘤的组织学类型、TNM分期、淋巴结转移、肝脏浸润、胰腺浸润、切缘癌残留、手术切除方式7个因素对预后的影响差异有统计学意义(P<0.05)。结论根治性切除是提高EHCC远期生存率及改善生活质量的关键,骨骼化切除联合肝叶切除和(或)胰十二指肠切除是提高远期疗效的重点。淋巴结转移、切缘癌残留是EHCC切除影响预后的独立因素。
Objective To investigate the clinical characteristics of extrahepatic cholangiocarcinoma (EHCC) and the effect of treatment on long-term survival and to investigate the prognostic factors after EHCC resection. Methods The clinical features, diagnosis, operation methods and follow-up results of 107 cases of EHCC admitted from January 1995 to December 2003 were retrospectively analyzed. Select the clinical factors that may affect the prognosis after EHCC resection and evaluate the prognosis by Cox proportional hazards model. Results 107 cases of EHCC underwent radical resection in 47 cases (7 cases of simple osteotomy, 12 cases of hepatectomy combined with resection of portal vein in 3 cases and 25 cases of pancreatoduodenectomy) In 12 cases, 45 cases were treated by internal or external drainage and 3 cases were exploratory surgery. The 1, 3, 5-year overall survival rates of EHCC were 58.2%, 30.0% and 13.1%, respectively. The survival rates at 1, 3 and 5 years after radical resection were 72.4%, 44.7% and 22.7% respectively. The 1, 2 and 3 year palliative resection rates were 54.5%, 27.3% and 9.1% . The 1-year, 2-year and 3-year survival rates in the drainage group were 32.1%, 17.2% and 8.6% respectively, with no survival for 4 years. There was significant difference in survival rate between radical resection group, palliative resection group, internal or external drainage group and non-surgical group (χ2 = 15.67, P <0.001). Tumor histological type, TNM stage, lymph node metastasis, liver infiltration, pancreatic invasion, marginal cancer residual, surgical resection 7 factors on the prognosis of the difference was statistically significant (P <0.05). Conclusions Radical resection is the key to improve the long-term survival rate and quality of life of EHCC. Skeletal resection combined with hepatectomy and / or pancreatoduodenectomy is the key to improve long-term efficacy. Lymph node metastasis, marginal cancer residual EHCC resection is an independent prognostic factor.