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目的探讨影响可手术切除的肝门部胆管癌患者预后的相关因素。方法对6年间行手术切除的44例肝门部胆管癌患者的临床资料和生存情况进行回顾性分析。结果 44例手术切除的类型,R0切除38例,R1切除6例,R2切除0例。25例患者切除后采用了将空肠袢断端前壁与胆管残端开口上方肝脏断向缝合的新胆管空肠吻合方式,19例患者采用了传统的胆肠吻合方式,新的吻合方式较传统吻合方式可明显减低胆瘘的发生(χ2=4.565,P=0.033)。单因素分析显示,影响患者术后生存期的因素为肿瘤的临床分期、手术切除的范围、是否R0切除以及淋巴结是否转移;而多因素分析显示,影响生存的独立危险因素为肿瘤的临床分期和是否R0切除(P<0.05)。结论影响术后肝门部胆管癌生存期的因素为肿瘤的临床分期和R0切除;采用新的吻合方式,可在尽量减少正常肝组织切除的条件下,保证肿瘤切除的彻底性。
Objective To investigate the prognostic factors of hilar cholangiocarcinoma patients with operable resection. Methods The clinical data and survival of 44 patients with hilar cholangiocarcinoma who underwent resection in 6 years were analyzed retrospectively. Results The type of surgical resection in 44 cases, R0 resection in 38 cases, R1 resection in 6 cases, R2 resection in 0 cases. Twenty-five patients had a new cholangiojejunal anastomosis, which cut the anterior wall of the jejunum at the anterior end of the stump and the liver above the open stump of the bile duct. Twenty-nine patients underwent traditional cholangio-intestinal anastomosis. The new anastomosis was more anastomosed Mode can significantly reduce the occurrence of biliary fistula (χ2 = 4.565, P = 0.033). Univariate analysis showed that the factors influencing the postoperative survival were the clinical staging, the scope of resection, R0 resection and lymph node metastasis. Multivariate analysis showed that the independent risk factors influencing survival were the clinical staging of tumor and Whether R0 resection (P <0.05). Conclusions The factors that influence the survival of hilar cholangiocarcinoma are the clinical stage and R0 resection. The new method of anastomosis can ensure the completeness of tumor resection under the condition of minimizing the resection of normal liver tissue.