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目的:分析不同部位肝外胆管癌的临床特点、手术治疗效果及预后影响因素。方法:回顾性分析2004年5月—2014年4月收治的87例肝外胆管癌患者资料。结果:87例患者中,肝门胆管癌58例,胆总管下端癌29例,患者均以黄疸为主要表现;56例行根治性手术切除,包括肝门胆管癌33例(56.9%,33/58),胆总管下端癌23例(79.3%,23/29),其余患者行姑息性减黄治疗或未予治疗。肝门胆管癌患者根治术后1、2、3年生存率分别为62.2%、35.1%、27.0%;AJCC分期和淋巴转移是总生存期的独立影响因素,而AJCC分期、淋巴转移、肝脏侵犯是无瘤生存期的独立影响因素(均P<0.05)。胆总管下端癌患者术后1、2、3年存活率分别为91.6%、54.2%、37.5%;影响总生存期和无瘤生存期的独立危险因素均为AJCC分期(均P<0.05)。肝门胆管癌与胆总管下端癌患者间,全部患者的总生存期、根治术后患者中位生存期与无瘤生存期及非根治术治疗后患者的中位生存期均无统计学差异(均P>0.05)。结论:对于不同位置的肝外胆管癌,根治性切除均是有效治疗方式,AJCC分期系统可有效评估预后。
Objective: To analyze the clinical features, surgical treatment and prognostic factors of extrahepatic cholangiocarcinoma in different sites. Methods: The clinical data of 87 patients with extrahepatic cholangiocarcinoma admitted to our hospital from May 2004 to April 2014 were analyzed retrospectively. Results: Of the 87 patients, 58 cases of hilar cholangiocarcinoma and 29 cases of common bile duct carcinoma were performed with jaundice. Fifty-six cases underwent radical surgical resection including 33 cases of hilar cholangiocarcinoma (56.9%, 33 / 58), 23 cases of common lower common bile duct cancer (79.3%, 23/29), and the remaining patients underwent palliative treatment with or without treatment. The 1, 2, 3-year survival rates of patients with hilar cholangiocarcinoma were 62.2%, 35.1% and 27.0% respectively. AJCC staging and lymphatic metastasis were independent prognostic factors of overall survival, while AJCC staging, lymphatic metastasis and liver invasion Is independent of disease-free survival factors (P <0.05). The survival rates at 1, 2, and 3 years after operation in lower common bile duct cancer patients were 91.6%, 54.2% and 37.5%, respectively. The independent risk factors influencing overall survival and disease free survival were all AJCC staging (all P <0.05). Between the patients with hilar cholangiocarcinoma and common bile duct cancer, the overall survival of all patients, median survival and disease-free survival after radical operation and the median survival of patients without non-radical surgery were not statistically different All P> 0.05). Conclusions: Radical resection is an effective treatment for extrahepatic cholangiocarcinoma in different locations. AJCC staging system can effectively evaluate the prognosis.