【摘要】：目的:探討影響患者接受根治性切除術(shù)后復(fù)發(fā)高危因素,幫助臨床醫(yī)師科學(xué)、全面評(píng)估患者預(yù)后,以便完善治療策略,更好地改善患者預(yù)后。方法:采用回顧性分析方法,收集寧夏醫(yī)科大學(xué)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(shù)患者的完整病例及隨訪資料72例,通過(guò)非條件Logistic回歸模型,選擇年齡、性別、術(shù)前是否合并膽道結(jié)石、術(shù)前總膽紅素及術(shù)前CA19-9水平、Bismuth-Corlette分型、術(shù)中出血量與輸血量、腫瘤大小、分化程度、淋巴結(jié)轉(zhuǎn)移及神經(jīng)浸潤(rùn)等12個(gè)研究指標(biāo),分析其對(duì)患者接受根治術(shù)后1年內(nèi)復(fù)發(fā)的影響。結(jié)果:72例接受根治性切除手術(shù)的患者中,26例術(shù)后1年內(nèi)復(fù)發(fā),復(fù)發(fā)率為36.1%,通過(guò)Logistic回歸模型多因素分析顯示,術(shù)前總膽紅素水平(OR=4.488,95%CI=1.058~19.031)、術(shù)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(jié)轉(zhuǎn)移(OR=4.143,95%CI=1.134~15.140)及神經(jīng)浸潤(rùn)(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(shù)后復(fù)發(fā)的高危因素。結(jié)論:肝門部膽管癌患者接受根治性切除手術(shù)后復(fù)發(fā)是影響其總體預(yù)后的重要原因;具體高危因素為術(shù)前總膽紅素及CA19-9水平、Bismuth-Corlette分型、伴有淋巴結(jié)轉(zhuǎn)移及神經(jīng)浸潤(rùn),在評(píng)估肝門部膽管癌患者預(yù)后方面有臨床指導(dǎo)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(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.8

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