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目的探讨胆管癌临床病理特征及术中、术后特点与预后的关系。方法回顾性分析2004年1月-2010年12月中国人民解放军总医院678例胆管癌术后患者,其中有随访结果 397例,仅对手术切除的胆管癌且非手术原因死亡的患者293例进行Cox比例风险模型分析。对所有指标进行单因素及多因素分析。结果 293例胆管癌患者中位随访时间为55.9个月,截止随访终点复发转移158例(53.9%),死亡223例(76.1%)。中位总生存时间21.2个月,1、3、5年生存率分别为71.7%、38.2%、10.6%。肿瘤分化程度、TNM分期、手术切缘、术中输血、肿瘤部位、血中碱性磷酸酶水平及复发是影响总生存时间的独立风险因素。结论肿瘤分化程度低、TNM分期晚、手术切缘有癌细胞浸润、术中输血、肿瘤位于肝外、血中碱性磷酸酶水平高于正常、肿瘤复发是影响胆管癌总生存的风险因素。
Objective To investigate the clinicopathological characteristics of cholangiocarcinoma and the relationship between intraoperative and postoperative characteristics and prognosis. Methods A retrospective analysis of 678 cases of postoperative cholangiocarcinoma patients from January 2004 to December 2010 in PLA General Hospital was conducted. Among them, 397 cases were followed up, of which 293 cases were performed only for resected cholangiocarcinoma and non-operative causes of death Cox proportional hazards model analysis. Univariate and multivariate analysis of all the indicators. Results The median follow-up time was 55.9 months in 293 patients with cholangiocarcinoma. Among them, 158 (53.9%) had recurrence and metastasis at the end of follow-up, and 223 (76.1%) died. The median overall survival time was 21.2 months, and the 1, 3, 5-year survival rates were 71.7%, 38.2% and 10.6%, respectively. Tumor differentiation, TNM staging, surgical margin, intraoperative blood transfusion, tumor site, blood alkaline phosphatase level and recurrence were independent risk factors influencing overall survival time. Conclusions The degree of tumor differentiation is low, the TNM stage is late, there is cancer cell infiltration at the surgical margin, intraoperative blood transfusion, the tumor is located outside the liver, the level of alkaline phosphatase in the blood is higher than normal, and tumor recurrence is the risk factor affecting the total survival of cholangiocarcinoma.