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目的:探讨中下段胆管癌的预后影响因素。方法:对79例中下段胆管癌患者的临床资料进行回顾性分析,采用Kaplan-Meier分析对确定的单因素进行生存率的描述,用Cox回归进行多因素分析,采用log-rank法对单因素进行生存分析评价。结果:79例患者1、3、5年生存率分别为70.2%,36.2%,19.1%,中位生存时间为19.8个月。行根治性手术患者1年、3年、5年生存率分别为87.9%、45.5%和24.2%,分别显著高于姑息性手术患者1年、3年、5年生存率(28.9%、14.3%和7.1%);行根治性手术患者的中位生存时间为34.5个月,较姑息性手术患者显著延长(8个月),根治术与姑息性手术1、3、5年生存率及中位生存时间比较四项均P<0.01,差异具有统计学意义。单因素分析显示肿瘤病理分化,慢性病史,淋巴结转移为影响中下段胆管癌预后的因素。多因素分析显示慢性病史、手术切缘、肿瘤病理分化程度是影响中下段胆管癌预后的独立危险因素。结论:慢性病史、手术切缘、肿瘤病理分化程度为中、下段胆管癌行切除术后预后的独立危险因素,根治性手术可提高中、下段胆管癌患者的生存率和延长其生存时间。
Objective: To investigate the prognostic factors of middle and lower bile duct cancer. Methods: The clinical data of 79 patients with cholangiocarcinoma of middle and lower segments were retrospectively analyzed. Kaplan-Meier analysis was used to describe the single factor survival rate. Cox regression was used for multivariate analysis. The log-rank method was used to evaluate the single factor Survival evaluation. Results: The 1-, 3- and 5-year survival rates of 79 patients were 70.2%, 36.2% and 19.1%, respectively. The median survival time was 19.8 months. The 1-year, 3-year and 5-year survival rates of patients who underwent radical surgery were 87.9%, 45.5% and 24.2% respectively, which were significantly higher than those of palliative surgery patients at 1 year, 3 years and 5 years (28.9%, 14.3% And 7.1%, respectively). The median survival time was 34.5 months in patients who underwent radical surgery, which was significantly longer than that in palliative surgery patients (8 months). The 1-year, 3-year and 5-year survival rates of patients undergoing radical operation and palliative surgery Survival time compared to four were P <0.01, the difference was statistically significant. Univariate analysis showed that tumor pathological differentiation, chronic medical history and lymph node metastasis were the prognostic factors of middle and lower bile duct cancer. Multivariate analysis showed that the history of chronic diseases, surgical margin, tumor pathological differentiation is an independent risk factor affecting the prognosis of middle and lower bile duct cancer. Conclusion: The chronic disease history, the surgical margin and the degree of tumor pathological differentiation are the independent risk factors for the prognosis of middle and lower cholangiocarcinoma after radical resection. Radical surgery can improve the survival rate and extend the survival time of patients with cholangiocarcinoma in the middle and lower segments.