The effect of different excision methods on the prognosis of type Ⅲ and Ⅳ hilar cholangiocarcinoma
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摘要:
目的 比较Ⅲ、Ⅳ型肝门胆管癌（hilar cholangiocarcinoma，HC）手术治疗方式及疗效。 方法 回顾性分析自2010年1月至2015年12月就诊于天津医科大学肿瘤医院行手术治疗的50例Ⅲ、Ⅳ型HC患者的临床资料。 结果 50例HC患者获得随访，中位随访时间为27个月。其中围肝门局限肝切除组13例，中位无复发时间为6个月，1、2年无复发率分别为30.8%、23.1%；中位生存时间为20个月，1、2年生存率分别为76.9%、38.5%；扩大肝切除组37例，中位无复发时间为14个月，1、2年无复发率分别为59.5%、32.4%；中位生存时间为37个月，1、2年生存率分别为83.8%、51.4%。扩大肝切除组无复发时间及生存时间均长于围肝门局限肝切除组（P＜0.05），1、2年无复发生存率及总生存率也更高（P＜0.05），但是两组并发症发生率及病死率并无显著差异（P＞0.05）。 结论 扩大肝切除术是延缓Ⅲ、Ⅳ型HC患者早期复发、改善生存预后的安全术式。 Abstract:Objective To compare the relationship between the operative strategies and clinical outcomes of type Ⅲ and Ⅳ hilar cholangiocarcinomas (HCs). Methods We retrospectively analyzed the clinical data and long-term outcomes for 50 cases of type Ⅲ and Ⅳ HC that underwent surgery at the Tianjin Medical University Cancer Hospital. Results Fifty patients were followed up and the median follow-up duration was 27 months. The hilar limited hepatectomy group included 13 cases; the median disease-free survival was 6 months, and 1-and 2-year disease-free survival rates were 30.8% and 23.1%, respectively. The median overall survival was 20 months, and the 1-and 2-year overall survival rates were 76.9% and 38.5%, respectively. The extended hepatectomy group included 37 cases; the median disease-free survival was 14 months, and 1-and 2-year disease-free survival rates were 59.5% and 32.4%, respectively. The median overall survival was 37 months, and the 1-and 2-year overall survival rates were 83.8% and 51.4%, respectively. Compared with the hilar limited hepatectomy group, the extended hepatectomy group had significantly longer median disease-free and overall survival (P < 0.05). The 1-and 2-year disease-free and overall survival rates were higher for the extended hepatectomy group. There was no significant difference in morbidity and mortality between the two groups (P > 0.05). Conclusions Extended hepatectomy is a safe operation that delays recurrence at early time points and improves the prognosis for patients with typeⅢand ⅣHC. -
Key words:
- cholangiocarcinoma hepatectomy /
- resection rate /
- postoperative complications /
- prognosis
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表 1 两组患者术前情况 n（%）
表 2 两组患者术中情况、术后并发症及恢复情况 n（%）
表 3 两组患者病理及辅助治疗 n（%）
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