本文選題：肝門部膽管癌　切入點(diǎn)：根治切除　出處：《浙江大學(xué)》2016年博士論文

【摘要】：目的：肝門部膽管癌是預(yù)后較差的惡性腫瘤,本研究旨在探討肝門部膽管癌根治切除術(shù)后生存的影響因素。方法：回顧性分析2010年1月至2014年12月期間在浙江大學(xué)附屬第一醫(yī)院肝膽外科診斷為肝門部膽管癌并行根治切除手術(shù)的78例患者的生存情況,選擇患者性別、年齡、術(shù)前總膽紅素水平、術(shù)前CA19-9水平、Bismuth-Corlette分型、腫瘤大小、腫瘤分化程度、淋巴結(jié)轉(zhuǎn)移、肝動(dòng)脈侵犯、門靜脈侵犯、肝實(shí)質(zhì)侵犯、手術(shù)方式、門靜脈切除重建以及術(shù)后化療等潛在的預(yù)后影響因素進(jìn)行單因素分析,再通過(guò)COX回歸模型進(jìn)行多因素分析。采用單變量模型探究轉(zhuǎn)移淋巴結(jié)個(gè)數(shù)與比例對(duì)存在淋巴結(jié)轉(zhuǎn)移患者預(yù)后的影響。結(jié)果：?jiǎn)我蛩胤治鲲@示術(shù)前總膽紅素水平≥10mg/dl、腫瘤大小≥2.5cm、存在淋巴結(jié)轉(zhuǎn)移、肝動(dòng)脈侵犯、門靜脈侵犯、肝實(shí)質(zhì)侵犯的患者預(yù)后較差(P0.05)。多因素分析證實(shí)術(shù)前總膽紅素水平(HR：2.515,P=0.002)、門靜脈侵犯(HR：2.038,P=0.049)和淋巴結(jié)轉(zhuǎn)移(HR：1.873,P=0.031)是影響肝門部膽管癌患者根治切除術(shù)后生存的獨(dú)立因素。對(duì)于存在淋巴結(jié)轉(zhuǎn)移的患者,轉(zhuǎn)移淋巴結(jié)比例≥0.20提示預(yù)后較差(P=0.048)。結(jié)論：肝門部膽管癌的預(yù)后受術(shù)前總膽紅素水平、腫瘤大小、淋巴結(jié)轉(zhuǎn)移、肝動(dòng)脈侵犯、門靜脈侵犯、肝實(shí)質(zhì)侵犯等多種因素的影響,其中術(shù)前總膽紅素水平、門靜脈侵犯、淋巴結(jié)轉(zhuǎn)移是肝門部膽管癌患者根治切除術(shù)后生存的獨(dú)立影響因素。對(duì)于存在淋巴結(jié)轉(zhuǎn)移的患者,轉(zhuǎn)移淋巴結(jié)比例0.20是評(píng)估預(yù)后的最佳截點(diǎn)。
[Abstract]:Objective: hilar cholangiocarcinoma is a malignant tumor with poor prognosis.Methods: from January 2010 to December 2014, 78 patients with hilar cholangiocarcinoma diagnosed by hepatobiliary surgery in the first affiliated Hospital of Zhejiang University were retrospectively analyzed.Preoperative total bilirubin level, preoperative CA19-9 level and Bismuth-Corlette classification, tumor size, tumor differentiation, lymph node metastasis, hepatic artery invasion, portal vein invasion, hepatic parenchyma invasion, operation mode,The potential prognostic factors such as portal vein resection and reconstruction and postoperative chemotherapy were analyzed by univariate analysis and multivariate analysis by COX regression model.Univariate model was used to investigate the influence of the number and proportion of metastatic lymph nodes on the prognosis of patients with lymph node metastasis.Results: univariate analysis showed that preoperative total bilirubin level 鈮，

本文編號(hào)：1691506