• 西安交通大學(xué)醫(yī)學(xué)院第一附屬醫(yī)院外科（西安710061）;

目的分析影響膽管癌切除術(shù)后的預(yù)后因素。
方法對(duì)我院1980~2004年期間120例膽管癌切除術(shù)后的患者進(jìn)行研究，選擇可能影響膽管癌切除術(shù)后預(yù)后的臨床病理因素，并通過Cox比例風(fēng)險(xiǎn)模型對(duì)其進(jìn)行多因素分析。
結(jié)果全組膽管癌切除術(shù)后的1、3和5年生存率分別為71.7%、32.5%和19.2%。單因素分析提示，腫瘤的組織學(xué)類型、淋巴結(jié)轉(zhuǎn)移、胰腺浸潤(rùn)、十二指腸浸潤(rùn)、切緣癌殘留、神經(jīng)浸潤(rùn)、周圍血管浸潤(rùn)和腫瘤浸潤(rùn)深度影響膽管癌的預(yù)后(P＜0.05)。Cox比例風(fēng)險(xiǎn)模型多因素分析結(jié)果提示，淋巴結(jié)轉(zhuǎn)移、胰腺浸潤(rùn)和神經(jīng)浸潤(rùn)是影響膽管癌切除手術(shù)預(yù)后的主要因素。
結(jié)論影響膽管癌切除術(shù)后患者預(yù)后的最重要因素是淋巴結(jié)轉(zhuǎn)移、胰腺浸潤(rùn)和神經(jīng)浸潤(rùn)。

引用本文： 孫學(xué)軍,石景森,何平. 影響膽管癌切除術(shù)后的預(yù)后因素分析. 中國(guó)普外基礎(chǔ)與臨床雜志, 2006, 13(1): 85-88. doi: 復(fù)制

1. Shinchi H, Takao S, Nishida H, et al. Length and quality of survival following external beam radiotherapy combined with expandable metallic stent for unresectable hilar cholangiocarcinoma [Ｊ]. J Surg Oncol, 2000; 75(2)∶89.
2. Reed DN Jr, Vitale GC, Martin R, et al. Bile duct carcinoma: trends in treatment in the nineties [Ｊ]. Am Surg, 2000; 66(8)∶711.
3. Lygidakis NJ, Sgourakis GJ, Dedemadi GV, et al. Longterm results following resectional surgery for Klatskin tumors. A twentyyear personal experience [Ｊ]. Hepatogastroenterology, 2001; 48(37)∶95.
4. Born P, Rosch T, Bruhl K, et al. Longterm outcome in patients with advanced hilar bile duct tumors undergoing palliative endoscopic or percutaneous drainage [Ｊ]. Z Gastroenterol, 2000; 38(6)∶483.
5. 周寧新， 黃志強(qiáng)， 馮玉泉， 等. 肝門部膽管癌103例外科治療遠(yuǎn)期療效的評(píng)析 [Ｊ]. 中華外科雜志， 1997； 35（11）∶64.
6. Yoshida T, Matsumoto T, Sasaki A, et al. Lymphatic spread differs according to tumor location in extrahepatic bile duct cancer [Ｊ]. Hepatogastroenterology, 2003; 50(49)∶17.
7. Yoshida T, Matsumoto T, Sasaki A, et al. Prognostic factors after pancreatoduodenectomy with extended lymphadenectomy for distal bile duct cancer [Ｊ]. Arch Surg, 2002; 137(1)∶69.
8. Todoroki T, Kawamoto T, Koike N, et al. Treatment strategy for patients with middle and lower third bile duct cancer [Ｊ]. Br J Surg, 2001; 88(3)∶364.
9. Havlik R, Sbisa E, Tullo A, et al. Results of resection for hilar cholangiocarcinoma with analysis of prognostic factors [Ｊ]. Hepatogastroenterology, 2000; 47(34)∶927.
10. Sakamoto Y, Kosuge T, Shimada K, et al. Prognostic factors of surgical resection in middle and distal bile duct cancer: an analysis of 55 patients concerning the significance of ductal and radial margins [Ｊ]. Surgery, 2005; 137(4)∶396.
11. Wakai T, Shirai Y, Moroda T, et al. Impact of ductal resection margin status on longterm survival in patients undergoing resection for extrahepatic cholangiocarcinoma [Ｊ]. Cancer, 2005; 103(6)∶1210.
12. Inoue K, Makuuchi M, Takayama T, et al. Longterm survival and prognostic factors in the surgical treatment of massforming type cholangiocarcinoma [Ｊ]. Surgery, 2000; 127(5)∶498.
13. 何平， 石景森， 陳武科， 等. 應(yīng)用Cox模型分析影響膽管癌切除術(shù)后的預(yù)后因素 [Ｊ]. 中華肝膽外科雜志， 2002； 8（4）∶219.
14. Bhuiya MR, Nimura Y, Kamiya J, et al. Clinicopathologic studies on perineural invasion of bile duct carcinoma [Ｊ]. Ann Surg, 1992; 215(4)∶344.
  1. 1. Shinchi H, Takao S, Nishida H, et al. Length and quality of survival following external beam radiotherapy combined with expandable metallic stent for unresectable hilar cholangiocarcinoma [Ｊ]. J Surg Oncol, 2000; 75(2)∶89.
  2. 2. Reed DN Jr, Vitale GC, Martin R, et al. Bile duct carcinoma: trends in treatment in the nineties [Ｊ]. Am Surg, 2000; 66(8)∶711.
  3. 3. Lygidakis NJ, Sgourakis GJ, Dedemadi GV, et al. Longterm results following resectional surgery for Klatskin tumors. A twentyyear personal experience [Ｊ]. Hepatogastroenterology, 2001; 48(37)∶95.
  4. 4. Born P, Rosch T, Bruhl K, et al. Longterm outcome in patients with advanced hilar bile duct tumors undergoing palliative endoscopic or percutaneous drainage [Ｊ]. Z Gastroenterol, 2000; 38(6)∶483.
  5. 5. 周寧新， 黃志強(qiáng)， 馮玉泉， 等. 肝門部膽管癌103例外科治療遠(yuǎn)期療效的評(píng)析 [Ｊ]. 中華外科雜志， 1997； 35（11）∶64.
  6. 6. Yoshida T, Matsumoto T, Sasaki A, et al. Lymphatic spread differs according to tumor location in extrahepatic bile duct cancer [Ｊ]. Hepatogastroenterology, 2003; 50(49)∶17.
  7. 7. Yoshida T, Matsumoto T, Sasaki A, et al. Prognostic factors after pancreatoduodenectomy with extended lymphadenectomy for distal bile duct cancer [Ｊ]. Arch Surg, 2002; 137(1)∶69.
  8. 8. Todoroki T, Kawamoto T, Koike N, et al. Treatment strategy for patients with middle and lower third bile duct cancer [Ｊ]. Br J Surg, 2001; 88(3)∶364.
  9. 9. Havlik R, Sbisa E, Tullo A, et al. Results of resection for hilar cholangiocarcinoma with analysis of prognostic factors [Ｊ]. Hepatogastroenterology, 2000; 47(34)∶927.
  10. 10. Sakamoto Y, Kosuge T, Shimada K, et al. Prognostic factors of surgical resection in middle and distal bile duct cancer: an analysis of 55 patients concerning the significance of ductal and radial margins [Ｊ]. Surgery, 2005; 137(4)∶396.
  11. 11. Wakai T, Shirai Y, Moroda T, et al. Impact of ductal resection margin status on longterm survival in patients undergoing resection for extrahepatic cholangiocarcinoma [Ｊ]. Cancer, 2005; 103(6)∶1210.
  12. 12. Inoue K, Makuuchi M, Takayama T, et al. Longterm survival and prognostic factors in the surgical treatment of massforming type cholangiocarcinoma [Ｊ]. Surgery, 2000; 127(5)∶498.
  13. 13. 何平， 石景森， 陳武科， 等. 應(yīng)用Cox模型分析影響膽管癌切除術(shù)后的預(yù)后因素 [Ｊ]. 中華肝膽外科雜志， 2002； 8（4）∶219.
  14. 14. Bhuiya MR, Nimura Y, Kamiya J, et al. Clinicopathologic studies on perineural invasion of bile duct carcinoma [Ｊ]. Ann Surg, 1992; 215(4)∶344.