【摘要】：目的：通過對肝門部膽管癌進(jìn)行術(shù)前可切除性的評估,分析影響其預(yù)后的相關(guān)因素,建立肝門部膽管癌預(yù)后評估模型,為進(jìn)一步加深對肝門部膽管癌的理解提供一定的理論基礎(chǔ)。 方法：回顧性分析154例肝門部膽管癌臨床與病理資料,采用Bismuth-Corlette分型、AJCC第7版腫瘤TNM分期以及Jarnagin-Blumgart分期方法進(jìn)行臨床分期,同時(shí)對影響肝門部膽管癌可切除性和預(yù)后的相關(guān)因素進(jìn)行分析,并建立基于改良Jamagin-Blumgart分期的肝門部膽管癌預(yù)后評估模型。 結(jié)果：根據(jù)Bismuth-Corlette分型：Ⅰ型根治性切除23例,根治切除率為63.8%,Ⅱ型根治性切除27例,根治切除率為57.4%,Ⅲ型根治性切除21例,根治切除率為45.7%,Ⅳ型根治性切除4例,根治切除率為16.0%。TNM分期：Ⅰ期根治性切除26例,Ⅱ期根治性切除28例,Ⅲ期根治性切除17例,Ⅳ期根治性切除4例。Jarnagin-Blumgart分期：T1期根治性切除42例,根治切除率為65.6%,T2期根治性切除25例,根治切除率為47.2%,T3期根治性切除8例,根治切除率為29.6%。總體1年生存率為65.9%、3年生存率為34.7%、5年生存率為21.4%,中位生存時(shí)間22個(gè)月。其中根治性手術(shù)1年生存率為74.3%、3年生存率為43.8%、5年生存率為33.5%,中位生存時(shí)間31個(gè)月；姑息性治療1年生存率為53.7%、3年生存率為25.7%、5年生存率為15.0%,中位生存時(shí)間14個(gè)月。年齡65歲以下的患者vs65歲以上的患者5年生存率的優(yōu)勢比為3.520,根治性治療vs姑息性治療的優(yōu)勢比為2.141,腫瘤范圍大小2cm以下vs2cm以上的優(yōu)勢比為1.608,CA199陰性的患者vs陽性的患者優(yōu)勢比為1.354,血清總膽紅素34.2μmol/L以下vs34.2μmol/L以上的優(yōu)勢比為1.322,腫瘤未發(fā)生轉(zhuǎn)移vs轉(zhuǎn)移的優(yōu)勢比為4.184。膽總管旁淋巴結(jié)未發(fā)生轉(zhuǎn)移vs轉(zhuǎn)移的優(yōu)勢比為1.231,肝總動(dòng)脈旁淋巴結(jié)未發(fā)生轉(zhuǎn)移vs轉(zhuǎn)移的優(yōu)勢比為2.125。治療方式(姑息性治療)、腫瘤分化(分化程度越低)、淋巴結(jié)轉(zhuǎn)移(陽性)、血管侵犯以及肝實(shí)質(zhì)受累會(huì)增加術(shù)后復(fù)發(fā)風(fēng)險(xiǎn)為1.326倍、2.328倍、3.596倍、4.406倍和2.536倍。基于改良Jamagin-Blumgart分期的肝門部膽管癌預(yù)后評估模型中分期Ⅰ對預(yù)后優(yōu)、分期Ⅱ?qū)︻A(yù)后良以及分期Ⅲ對預(yù)后差的準(zhǔn)確率分別為57.6%,78.6%和73.5%,總體準(zhǔn)確率為69.5%。 結(jié)論：CA199、腫瘤位置、門靜脈受累、肝動(dòng)脈受累、淋巴結(jié)轉(zhuǎn)移以及遠(yuǎn)處轉(zhuǎn)移和腫瘤是否可切除相關(guān)。肝門部膽管癌的預(yù)后生存受治療方式、腫瘤范圍大小、總膽紅素水平、臨床分期以及腫瘤是否轉(zhuǎn)移等多種因素的影響；淋巴結(jié)是否轉(zhuǎn)移、清掃的數(shù)目及具體區(qū)域淋巴結(jié)轉(zhuǎn)移情況對患者的預(yù)后也有影響。治療方式(姑息性治療)、腫瘤分化(分化程度越低)、淋巴結(jié)轉(zhuǎn)移(陽性)、血管侵犯以及肝實(shí)質(zhì)受累會(huì)增加術(shù)后復(fù)發(fā)風(fēng)險(xiǎn)�；诟牧糐arnagin-Blumgart分期的肝門部膽管癌預(yù)后評估模型的準(zhǔn)確率高于其他臨床分期,能更好地指導(dǎo)手術(shù)方案的制定,進(jìn)而在術(shù)后早期對患者的預(yù)后生存時(shí)間有一個(gè)預(yù)測。
[Abstract]:Objective: to evaluate the resectability of hilar cholangiocarcinoma before operation, and to analyze the factors influencing the prognosis of hilar cholangiocarcinoma, and to establish a model for evaluating the prognosis of hilar cholangiocarcinoma. To provide a theoretical basis for further understanding of hilar cholangiocarcinoma. Methods: the clinical and pathological data of 154 cases of hilar cholangiocarcinoma were retrospectively analyzed. The clinical staging was performed by Bismuth-Corlette classification, TNM staging of AJCC seventh edition tumor and Jarnagin-Blumgart staging. At the same time, the factors influencing the resectability and prognosis of hilar cholangiocarcinoma were analyzed, and the prognostic evaluation model of hilar cholangiocarcinoma based on modified Jamagin-Blumgart staging was established. Results: according to Bismuth-Corlette classification, the radical resection rate was 63.8% in 23 cases of type 鈪，

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