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目的探讨晚期胆管癌三维适形放射治疗(three-dimensional conformal radiotherapy 3DCRT)的疗效及相关因素对预后的影响。方法回顾分析了45例晚期胆管癌3DCRT患者的资料。用Kaplan-Meier法计算患者的生存率;通过Cox比例风险模型对晚期胆管癌行3DCRT的患者进行多因素分析。结果晚期胆管癌经3DCRT后获得了82.2%(37/45)的肿瘤局部控制率。其1,2年生存率分别为53.3%(23/43)和16.3%(7/43),中位生存期为13.7个月。治疗后患者Karnofsky评分平均增高15.3分。治疗中33例患者出现1~2级急性胃肠道反应,5例出现3级胃肠道反应,5例放疗后1~3个月内出现十二指肠溃疡,2例发生胃溃疡,其中1例因十二指肠溃疡大出血死亡,其余6例经对症处理后好转。Cox比例风险模型多因素分析结果显示,年龄、内引流术、淋巴结转移和Karnofsky评分对患者生存率的影响有统计学意义(P<0.05)。结论3DCRT对晚期胆管癌患者局部治疗效果明显,能有效提高患者的生存率和生活质量,而年龄、内引流术、淋巴结转移和Karnofsky评分是患者预后的重要影响因素。
Objective To investigate the effect of three-dimensional conformal radiotherapy (3DCRT) on the prognosis of advanced cholangiocarcinoma and its related factors. Methods The data of 45 patients with advanced cholangiocarcinoma 3DCRT were retrospectively analyzed. The survival rate of patients was calculated by Kaplan-Meier method. Multivariate analysis was performed on patients with advanced cholangiocarcinoma who underwent 3DCRT by Cox proportional hazards model. Results The local control rate of 82.2% (37/45) was obtained after 3DCRT in advanced cholangiocarcinoma. The 1- and 2-year survival rates were 53.3% (23/43) and 16.3% (7/43), respectively. The median survival time was 13.7 months. After treatment, patients with Karnofsky score an average increase of 15.3 points. In the treatment group, there were 1 to 2 acute gastrointestinal reactions in 33 patients, 3 gastrointestinal reactions in 5 patients, duodenal ulcer in 1 to 3 months after 5 patients and gastric ulcer in 2 patients One patient died of bleeding due to duodenal ulcer, and the remaining 6 patients improved after symptomatic treatment. Cox proportional hazards model multivariate analysis showed that age, internal drainage, lymph node metastasis and Karnofsky score on the survival rate was statistically significant (P <0.05). Conclusion 3DCRT has obvious effect on local treatment of patients with advanced cholangiocarcinoma, which can effectively improve the survival rate and quality of life. Age, internal drainage, lymph node metastasis and Karnofsky score are important prognostic factors in patients with advanced cholangiocarcinoma.