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晚期肝门部胆管癌(III-IV期)患者治疗效果评估:介入治疗的临床意义

Assessment of treatment outcomes in patients with advanced hilar cholangiocarcinoma (stages III-IV): Clinical significance of interventional therapy.

作者信息

Zhao Hai-Ping, Zhang Zheng-Hua, Zheng Ai-Hong

机构信息

Department of General Surgery, The First People's Hospital of Fuyang, Hangzhou, Zhejiang.

Department of Clinical Oncology, Jing'an District Centre Hospital of Shanghai, Shanghai.

出版信息

Medicine (Baltimore). 2018 Sep;97(39):e11550. doi: 10.1097/MD.0000000000011550.

DOI:10.1097/MD.0000000000011550
PMID:30278479
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6181544/
Abstract

The clinical significance of palliative interventional therapy in the management of patients with advanced hilar cholangiocarcinoma (HCCA; stages III-IV) has yet to be studied. The present work was aimed to compare the clinical outcomes of the patients treated with surgery or interventional therapy.A total of 90 patients with advanced HCCA, who admitted Fuyang First People's Hospital from May 2015 to February 2016, were enrolled. Forty-five of them were assigned to the experimental group receiving biliary drainage as the interventional therapy, and the remaining 45 patients were designated as the conventional group receiving radical/palliative surgery. Before and after the treatment total bilirubin from blood was measured. The length of treatment and medical cost were also examined. All patients were followed up for at least 1 year after the treatment.For both the experimental and conventional groups, the serum bilirubin levels after treatment were significantly lower than those before treatment (P < .05); however, no significant differences between groups were seen. There were no significant differences between experimental and conventional groups in the incidence of postoperative complications and survival outcomes. Of note, the length of treatment of the experimental group was substantially shorter than that of the conventional group (P < .05). The medical expense of the experimental group was only about one-third of that of the conventional group (P < .05).Although the interventional therapy does not improve patients' survivals and reduce the incidence of complications, it significantly shortens the treatment length, reducing substantially the medical expense. This finding provides new insights into the treatment strategy for patients with advanced HCCA.

摘要

姑息性介入治疗在晚期肝门部胆管癌(HCCA;Ⅲ - Ⅳ期)患者管理中的临床意义尚未得到研究。本研究旨在比较接受手术或介入治疗患者的临床结局。

共纳入90例2015年5月至2016年2月在阜阳市第一人民医院收治的晚期HCCA患者。其中45例被分配至实验组接受胆道引流作为介入治疗,其余45例患者被指定为接受根治性/姑息性手术的传统组。测量治疗前后血液中的总胆红素水平。还检查了治疗时长和医疗费用。所有患者在治疗后均随访至少1年。

实验组和传统组治疗后的血清胆红素水平均显著低于治疗前(P < 0.05);然而,两组之间未见显著差异。实验组和传统组在术后并发症发生率和生存结局方面无显著差异。值得注意的是,实验组的治疗时长明显短于传统组(P < 0.05)。实验组的医疗费用仅约为传统组的三分之一(P < 0.05)。

尽管介入治疗并未改善患者的生存率和降低并发症发生率,但它显著缩短了治疗时长,大幅降低了医疗费用。这一发现为晚期HCCA患者的治疗策略提供了新的见解。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6bb7/6181544/bb0a27d3b884/medi-97-e11550-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6bb7/6181544/bb0a27d3b884/medi-97-e11550-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6bb7/6181544/bb0a27d3b884/medi-97-e11550-g001.jpg

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本文引用的文献

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Surgical management of biliary tract cancers.胆道癌的外科治疗
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Percutaneous transhepatic biliary drainage and stenting for malignant obstructive jaundice: A report of two cases.经皮经肝胆道引流及支架置入术治疗恶性梗阻性黄疸:2例报告
Exp Ther Med. 2015 Oct;10(4):1503-1506. doi: 10.3892/etm.2015.2701. Epub 2015 Aug 24.
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Principles of surgical resection in hilar cholangiocarcinoma.肝门部胆管癌的手术切除原则。
胆管癌的诊断与治疗管理
World J Clin Cases. 2019 Jul 26;7(14):1732-1752. doi: 10.12998/wjcc.v7.i14.1732.
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