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两种肝切除方法对肝内胆管癌患者生存结局影响的多因素分析

[Multivariate analysis of the effect of two liver resection methods on the survival outcome of patients with intrahepatic cholangiocarcinoma].

作者信息

Han X S, Li Q W, Guo P L, Li J J

机构信息

Department of Gastrointestinal Hepatobiliary Surgery, Shangqiu First Hospital, Shangqiu 476000,China.

出版信息

Zhonghua Yi Xue Za Zhi. 2022 May 17;102(18):1364-1368. doi: 10.3760/cma.j.cn112137-20220119-00142.

Abstract

To investigate the effect of anatomical hepatectomy and non-anatomic hepatectomy in the treatment of elderly patients with intrahepatic cholangiocarcinoma (IHCC) and their impact on survival outcomes. In this study, a retrospective method was used to select elderly patients with IHCC who were surgically treated in Shangqiu First People's Hospital from April 2014 to April 2018, and were divided into anatomic resection group and non-anatomical resection group according to the surgical methods they received.The factors affecting the survival outcome of IHCC in the two liver resection methods were analyzed and compared, as well as the effects of liver cirrhosis rate, TNM stage, ascites rate, lymph node metastasis rate, and vascular invasion rate on survival. A total of 181 cases were included in this study, including 87 cases in the anatomical resection group, with 54 males and 33 females, aged (71.4±5.2) years old;There were 94 cases in the non-anatomical resection group, including 49 males and 45 females, aged (70.8±4.8) years.The 3-year survival rate of the anatomical resection group was 41.4% (36/87), which was higher than that of the non-anatomical resection group (25.5% (24/94), the difference was statistically significant (<0.05);The median survival time of the anatomic resection group was longer than that of the non-anatomical resection group, and the difference was statistically significant <0.05;The patient's TNM stage was stage III [ (95%): 2.168 (1.245-3.776)], lymph node metastasis [1.664 (1.087-2.545)], and vascular invasion [1.883 (1.167-3.038)] was an independent risk factor for death 3 years after surgery (<0.05), The patient's anatomical liver resection was a protective factor for the 3-year follow-up survival (<0.05). The postoperative survival of elderly patients with IHCC is affected by many factors, but anatomic liver resection is beneficial to prolong the survival time of patients.

摘要

探讨解剖性肝切除术与非解剖性肝切除术治疗老年肝内胆管癌(IHCC)的效果及其对生存结局的影响。本研究采用回顾性方法,选取2014年4月至2018年4月在商丘市第一人民医院接受手术治疗的老年IHCC患者,根据其接受的手术方式分为解剖性切除组和非解剖性切除组。分析比较两种肝切除方法中影响IHCC生存结局的因素,以及肝硬化率、TNM分期、腹水率、淋巴结转移率和血管侵犯率对生存的影响。本研究共纳入181例患者,其中解剖性切除组87例,男性54例,女性33例,年龄(71.4±5.2)岁;非解剖性切除组94例,男性49例,女性45例,年龄(70.8±4.8)岁。解剖性切除组3年生存率为41.4%(36/87),高于非解剖性切除组(25.5%(24/94),差异有统计学意义(<0.05);解剖性切除组的中位生存时间长于非解剖性切除组,差异有统计学意义<0.05;患者的TNM分期为Ⅲ期[(95%):2.168(1.245 - 3.776)]、淋巴结转移[1.664(1.087 - 2.545)]和血管侵犯[1.883(1.167 - 3.038)]是术后3年死亡的独立危险因素(<0.05),患者的解剖性肝切除是3年随访生存的保护因素(<0.05)。老年IHCC患者术后生存受多种因素影响,但解剖性肝切除有利于延长患者生存时间。

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