發(fā)布時間：2018-09-12 17:55

【摘要】：目的:探討影響患者接受根治性切除術后復發(fā)高危因素,幫助臨床醫(yī)師科學、全面評估患者預后,以便完善治療策略,更好地改善患者預后。方法:采用回顧性分析方法,收集寧夏醫(yī)科大學總醫(yī)院及寧夏人民醫(yī)院肝膽外科2000年1月至2015年12月接受肝門部膽管癌根治性切除手術患者的完整病例及隨訪資料72例,通過非條件Logistic回歸模型,選擇年齡、性別、術前是否合并膽道結石、術前總膽紅素及術前CA19-9水平、Bismuth-Corlette分型、術中出血量與輸血量、腫瘤大小、分化程度、淋巴結轉移及神經(jīng)浸潤等12個研究指標,分析其對患者接受根治術后1年內復發(fā)的影響。結果:72例接受根治性切除手術的患者中,26例術后1年內復發(fā),復發(fā)率為36.1%,通過Logistic回歸模型多因素分析顯示,術前總膽紅素水平(OR=4.488,95%CI=1.058~19.031)、術前CA19-9水平(OR=5.944,95%CI=1.491~23.693)、Bismuth-Corlette分型(OR=4.494,95%CI=1.254~16.110)、淋巴結轉移(OR=4.143,95%CI=1.134~15.140)及神經(jīng)浸潤(OR=5.343,95%CI=1.101~25.920)是影響肝門部膽管癌患者接受根治性切除手術后復發(fā)的高危因素。結論:肝門部膽管癌患者接受根治性切除手術后復發(fā)是影響其總體預后的重要原因;具體高危因素為術前總膽紅素及CA19-9水平、Bismuth-Corlette分型、伴有淋巴結轉移及神經(jīng)浸潤,在評估肝門部膽管癌患者預后方面有臨床指導意義。
[Abstract]:Objective: to explore the risk factors of recurrence after radical resection, to help clinicians to evaluate the prognosis of patients and to improve the prognosis of patients. Methods: the complete cases and follow-up data of 72 patients undergoing radical resection of hilar cholangiocarcinoma in the General Hospital of Ningxia Medical University and the Department of Hepatobiliary surgery in Ningxia people's Hospital from January 2000 to December 2015 were retrospectively analyzed. Age, sex, preoperative total bilirubin and preoperative CA19-9 level were determined by non conditional Logistic regression model. Blood loss and blood transfusion volume, tumor size and differentiation degree were determined. The influence of lymph node metastasis and nerve infiltration on recurrence within 1 year after radical operation was analyzed. Results among the 72 cases undergoing radical resection, 26 cases recurred within one year after operation, and the recurrence rate was 36.1%. The multivariate analysis of Logistic regression model showed that, Preoperative total bilirubin level (OR=4.488,95%CI=1.058~19.031), preoperative CA19-9 level (OR=5.944,95%CI=1.491~23.693) Bismuth-Corlette classification (OR=4.494,95%CI=1.254~16.110), lymph node metastasis (OR=4.143,95%CI=1.134~15.140) and nerve invasion (OR=5.343,95%CI=1.101~25.920) were high risk factors for recurrence of hilar cholangiocarcinoma after radical resection. Conclusion: recurrence after radical resection of hilar cholangiocarcinoma is an important factor affecting the overall prognosis, and the specific high risk factors are preoperative total bilirubin and CA19-9 level Bismuth-Corlette classification with lymph node metastasis and nerve invasion. It has clinical significance in evaluating the prognosis of hilar cholangiocarcinoma.
【學位授予單位】：寧夏醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.8

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