肝内胆管结石合并肝内胆管癌的外科治疗作用：单中心回顾性研究
Role of surgical treatment for hepatolithiasis-associated intrahepatic cholangiocarcinoma: A retrospective study in a single institution.
作者信息
Xiao Jian, Zhu Jisheng, Liu Zhanying, Wan Renhua, Li Yong, Xiao Weidong
机构信息
Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
出版信息
J Cancer Res Ther. 2017;13(5):756-760. doi: 10.4103/jcrt.JCRT_356_17.
CONTEXT
The extent of hepatectomy and lymph node dissection (LND) in the treatment of hepatolithiasis-associated intrahepatic cholangiocarcinoma (HL-iCCA) is still controversial.
AIMS
The aim of this retrospective study was to evaluate the role of surgical treatment for HL-iCCA.
METHODS
The clinical data of 63 patients with HL-iCCA who undergoing surgery between January 2005 and December 2015 were analyzed retrospectively.
STATISTICAL ANALYSIS USED
All data were analyzed by the SPSS 17.0 software program (IMB Inc., Chicago, IL, USA). Survival curves were analyzed by the Kaplan-Meier method and compared by the Log-rank test. A P < 0.05 was considered statistically significant.
RESULTS
Forty-nine patients (77.8%) underwent surgical resection including 35 with LND and 14 without LND. The overall 1-, 3-, and 5-year survival rates were 58.1%, 28.2%, and 10.6%, respectively, and the median survival time was 19 months. The 1-, 3-, and 5-year survival rates of resection group were 78.9%, 36.3%, and 13.5%, respectively, while the 1-year survival rate of exploratory laparotomy group was 0 (P < 0.0001). The 1-, 3-, and 5-year survival rates of patients with LND were significantly superior to those of without LND (75.9%, 39.4%, and 20.2% vs. 71.4%, 17.9%, and 0, P = 0.043). According to the N status, the 1-, 3-, and 5-year survival rates of pN0 subgroup were 81.8%, 49.2%, and 28.1%; pN1 subgroup were 65.3%, 18.6%, and 0%; and pNx subgroup were 71.4%, 17.9%, and 0%, respectively (pN0 vs. pN1, P = 0.005; pN0 vs. pNx, P = 0.004; pN1 vs. pNx, P = 0.653). The 1-, 3-, and 5-year survival rates of R0 resection (n = 42) were 80.2%, 36.7%, and 14.9%, respectively, and those of R1 resection (n = 7) were 71.4%, 0%, and 0%, respectively (P = 0.028).
CONCLUSIONS
Radical resection is the most effective therapy for HL-iCCA. Regional lymphadenectomy is strongly recommended in resectable HL-iCCA, which is helpful in tumor staging and long-term survival.
背景
肝切除术和淋巴结清扫术（LND）在肝内胆管结石病相关肝内胆管癌（HL-iCCA）治疗中的范围仍存在争议。
目的
本回顾性研究旨在评估手术治疗对HL-iCCA的作用。
方法
回顾性分析2005年1月至2015年12月期间接受手术的63例HL-iCCA患者的临床资料。
统计分析方法
所有数据采用SPSS 17.0软件程序（美国伊利诺伊州芝加哥市IBM公司）进行分析。生存曲线采用Kaplan-Meier法分析，并通过Log-rank检验进行比较。P<0.05被认为具有统计学意义。
结果
49例（77.8%）患者接受了手术切除，其中35例行LND，14例未行LND。总体1年、3年和5年生存率分别为58.1%、28.2%和10.6%，中位生存时间为19个月。切除组的1年、3年和5年生存率分别为78.9%、36.3%和13.5%，而剖腹探查组的1年生存率为0（P<0.0001）。行LND患者的1年、3年和5年生存率显著高于未行LND者（75.9%、39.4%和20.2% vs. 71.4%、17.9%和0，P = 0.043）。根据N分期，pN0亚组的1年、3年和5年生存率分别为81.8%、49.2%和28.1%；pN1亚组分别为65.3%、18.6%和0%；pNx亚组分别为71.4%、17.9%和0%（pN0 vs. pN1，P = 0.005；pN0 vs. pNx，P = 0.004；pN1 vs. pNx，P = 0.653）。R0切除（n = 42）患者的1年、3年和5年生存率分别为80.2%、36.7%和14.9%，R1切除（n = 7）患者的生存率分别为71.4%、0%和0%（P = 0.028）。
结论
根治性切除是HL-iCCA最有效的治疗方法。强烈建议对可切除的HL-iCCA行区域淋巴结清扫术，这有助于肿瘤分期和长期生存。
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