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目的分析外科手术治疗后的肝内胆管细胞癌病人临床病理特征与生存时间的相关性。方法从1996年11月至2000年5月共有104例肝内胆管细胞癌病人接受手术治疗。对其临床资料进行归纳,并随访调查。成功回访79例(76·0%)。对16个临床病理因素(年龄、性别、慢性肝病史、HBsAg携带、手术方式、辅助治疗、腹水、淋巴结转移、邻近器官侵犯、肿瘤大小、肿瘤坏死、肿瘤包膜、肝内转移、TNM分期、组织学分级、肝硬化)进行了单因素和多因素相关分析,以了解它们对治疗预后的影响。结果79例病人的1,3,5年生存率分别为49·4%,17·3%和9·6%。单因素相关分析显示性别(P=0·0221),HBsAg携带(P=0·0115),手术方式(P=0·0042),辅助治疗(P=0·0389),腹水(P=0·0001),临近器官侵犯(P=0·0220),肝内转移(P=0·0000),TNM分期(P=0·0001)与生存时间相关。多因素分析表明HBsAg携带、腹水和TNM分期与预后显著相关。结论早期诊断和早期治疗以及规则性肝切除是改善肝内胆管细胞癌外科治疗效果的关键因素。
Objective To analyze the correlation between the clinicopathological features and survival time of patients with intrahepatic cholangiocarcinoma after surgical treatment. Methods From November 1996 to May 2000 a total of 104 patients with intrahepatic cholangiocarcinoma underwent surgery. The clinical data were summarized and followed up for investigation. A total of 79 cases (76.0%) were successfully interviewed. Sixteen clinical and pathological factors including age, sex, history of chronic liver disease, HBsAg-carrying, surgical modalities, adjuvant therapy, ascites, lymph node metastases, adjacent organ invasion, tumor size, tumor necrosis, tumor envelope, intrahepatic metastasis, TNM staging, Histological grade, liver cirrhosis) were univariate and multivariate correlation analysis to understand their impact on the prognosis of treatment. Results The 1, 3, 5-year survival rates of 79 patients were 49.4%, 17.3% and 9.6% respectively. Univariate correlation analysis showed that gender (P = 0 · 0221), HBsAg-carrying (P = 0 · 01 05), operation (P = 0.0042), adjuvant therapy (P = 0.00220), intrahepatic metastasis (P = 0.0000), TNM stage (P = 0.0001) were associated with survival time. Multivariate analysis showed that HBsAg-carrying, ascites and TNM staging correlated significantly with prognosis. Conclusion Early diagnosis and early treatment and regular hepatectomy are the key factors to improve the surgical treatment of intrahepatic cholangiocarcinoma.