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目的 研究影响远端胆管癌手术预后的因素 ,探讨提高远端胆管癌疗效的途径。方法回顾分析 1996年 2月至 2 0 0 2年 12月远端胆管癌手术治疗患者的临床资料 ,用Cox回归模型 ,选择14个对预后可能产生影响的因素进行统计学分析。结果 173例患者中 ,男性 99例 ,女性 74例 ,年龄 2 7～ 74岁 ,平均年龄 5 5 5岁。其中 15 2例行根治性切除术 ,根治性切除率为 87 9%。 2 9例死于术后肝转移 ,占死亡病例的 4 6 8%。统计分析结果显示患者的预后与手术方式、病理分型、是否淋巴结转移显著相关 ,而与是否输血、侵犯胰腺、放疗、化疗、ERCP以及肿瘤大小、CA 19 9、TBIL、A/G(白球蛋白比 )、性别和年龄等无明显相关。结论 根治性手术是主要的治疗措施 ;对术后肝转移的积极预防和治疗是提高远端胆管癌生存率的重要策略。
Objective To study the factors affecting the prognosis of distal cholangiocarcinoma and to explore ways to improve the efficacy of distal cholangiocarcinoma. Methods The clinical data of patients with distal cholangiocarcinoma from February 1996 to December 2002 were retrospectively analyzed. Cox regression model was used to select 14 factors that may affect the prognosis. Results Of 173 patients, 99 were male and 74 were female, ranging in age from 27 to 74 years with a mean age of 555 years. Fifteen of the patients underwent radical resection and the radical resection rate was 87.9%. 29 cases died of postoperative liver metastases, accounting for 46.8% of the deaths. The results of statistical analysis showed that the prognosis of patients was significantly related to the operation method, pathological type and lymph node metastasis. However, whether the blood transfusion, invasion of pancreas, radiotherapy, chemotherapy, ERCP, tumor size, CA 19 9, TBIL, A / Than), gender and age, no significant correlation. Conclusions Radical surgery is the main treatment. Active prevention and treatment of postoperative liver metastasis is an important strategy to improve the survival rate of distal cholangiocarcinoma.