Yi Bin, Zhang Bai-he, Zhang Yong-jie, Jiang Xiao-qing, Zhang Bao-hua, Yu Wen-long, Cheng Qing-bao, Wu Meng-chao
Department of Biliary Surgery, Eastern Heapatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China.
Zhonghua Wai Ke Za Zhi. 2005 Jul 1;43(13):842-5.
To explore the prognosis factors of hilar cholangiocarcinoma, and investigate the relation between operative procedure and prognosis of it.
A retrospective cohort study was investigated in 198 patients with hilar cholangiocarcinoma, who were treated in our hospital from December 1997 to December 2002. There were 117 males and 81 females. The age ranged from 27 to 81 years old with a mean of 56. Jaundice (94.5%), pruritus (56.6%) and abdominal pain (33.8%) were the main present symptoms. According to Bismuth-Corlette classification, there were 14 type I cases, 19 type II cases, 12 type IIIa cases, 15 type IIIb cases, 112 type IV cases and 26 unclassifiable cases. One hundred and forty four cases received open operative treatment, and the others only were treated with endoscopic approach (including ERBD or EMBE 21 cases, ENBD 31 cases) or percutaneous transhepatic cholangiodrainage (2 cases). Tumor resection was performed on 120 cases with a resection rate of 83.3%, included radical resection 59 cases (41.0%). Twenty-four cases underwent paunched biliary exploration and drainage.
The Cox's regression model analysis showed that occupation, preoperative maximum total serum bilirubin level, operative procedure and postoperative adjuvant radiation affected postoperative survival significantly, but gender, age, choledocholithiasis, hepatitis, preoperative serum CA19-9 level, Bismuth-Corlette type, histopathologic grading and postoperative chemotherapy were not significant prognostic factors. The postoperative survival of biliary drainage group, palliative resection group and radical resection group, which statistically differed pairwise. Between ERBD or EMBE group and palliative resection group, there was no statistical difference. So was between ERBD or EMBE group and biliary drainage group, or between ENBD group and biliary drainage group. The survival differed statistically between ERBD or EMBE group and ENBD group.
Operative procedure was the most important prognosic factor of hilar cholangiocarcinoma, radical resection still was the primary measure to cure and long term survival. For irresectable hilar cholangiocarcinoma, the effect of ERBD or EMBE could not be considered to be worse than that of open operative treatment.
探讨肝门部胆管癌的预后因素，研究手术方式与肝门部胆管癌预后的关系。
对1997年12月至2002年12月在我院治疗的198例肝门部胆管癌患者进行回顾性队列研究。其中男性117例，女性81例。年龄27至81岁，平均56岁。主要症状为黄疸（94.5%）、瘙痒（56.6%）和腹痛（33.8%）。根据Bismuth-Corlette分型，Ⅰ型14例，Ⅱ型19例，Ⅲa型12例，Ⅲb型15例，Ⅳ型112例，无法分型26例。144例行开腹手术治疗，其余仅行内镜治疗（包括内镜逆行胆管引流术或内镜鼻胆管引流术21例，内镜鼻胆管引流术31例）或经皮经肝胆管引流术（2例）。120例行肿瘤切除术，切除率为83.3%，其中根治性切除59例（41.0%）。24例行剖腹胆管探查及引流术。
Cox回归模型分析显示，职业、术前血清总胆红素最高水平、手术方式及术后辅助放疗对术后生存有显著影响，但性别、年龄、胆总管结石、肝炎、术前血清CA19-9水平、Bismuth-Corlette分型、组织病理学分级及术后化疗不是显著的预后因素。胆管引流组、姑息性切除组和根治性切除组的术后生存情况，两两之间差异有统计学意义。内镜逆行胆管引流术或内镜鼻胆管引流术组与姑息性切除组之间无统计学差异。内镜逆行胆管引流术或内镜鼻胆管引流术组与胆管引流组之间、内镜鼻胆管引流术组与胆管引流组之间也无统计学差异。内镜逆行胆管引流术或内镜鼻胆管引流术组与内镜鼻胆管引流术组之间的生存情况差异有统计学意义。
手术方式是肝门部胆管癌最重要的预后因素，根治性切除仍是治愈及长期生存的主要措施。对于无法切除的肝门部胆管癌，内镜逆行胆管引流术或内镜鼻胆管引流术的效果不能认为比开腹手术治疗差。
