| 摘要: |
| 目的:分析肝内胆管癌(intrahepatic cholangiocarcinoma,ICC)患者手术后行肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)的疗效,探讨ICC术后是否应常规行TACE来预防肿瘤的复发。 方法:回顾性分析我院2005年7至12月经手术切除后病理诊断为ICC的80例患者的临床资料。其中术后行TACE治疗的患者36例(A组),术后未行TACE治疗的患者44例(B组),比较两组的一般资料及实验室检查情况,随访所有患者术后0.5、1、2、3年的生存情况并作统计学处理,分析与生存相关的危险因素。结果:A组和B组患者在性别，年龄，乙肝病史，肝硬化，实验室检查如乙肝表面抗原(HBsAg)、甲胎蛋白(AFP)、癌胚抗原(CEA)、人糖链抗原19-9(CA19-9)、丙氨酸转氨酶(ALT)和总胆红素(TBIL)，肿瘤大小，肿瘤数量，肝门部淋巴结转移等一般资料上无统计学差异。两组患者0.5、1、2、3年生存率分别为80.6％和81.8％(χ2＝0.082 2,P＝0.774 4),63.9％和65.9％(χ2＝0.418 7,P=0.517 6),25.0％和22.7％(χ2＝0.118 7，P=0.730 5),8.3％和9.1％(χ2＝0.115 7,P=0.733 7),差异无统计学意义。COX回归分析显示,CEA、CA19-9和肝门部淋巴结转移是影响患者生存率的独立危险因素,危险系数分别为2.930(P=0.012 5)、19.913(P<0.001)和17.791(P<0.001),而术后是否行TACE治疗并非影响生存的独立危险因素。结论:肝内胆管癌手术后行TACE治疗并不能有效提高患者的生存率,因此不主张ICC术后常规行TACE以防止肿瘤的复发。 |
| 关键词: 肝肿瘤 肝内胆管癌 肝切除术 经导管肝动脉化疗栓塞本 |
| DOI：10.3724/SP.J.1008.2009.01385 |
| 投稿时间：2009-01-05修订日期：2009-09-04 |
| 基金项目: |
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| Transcatheter arterial chemoembolization after surgical excision of intrahepatic cholangiocarcinoma:an analysis of outcomes |
| WANG Chao,TONG Ying,LIN Chuan,LIU Gang,YANG Jia-he,WU Meng-chao* |
| (Department of Comprehensive Treatment Ⅲ,Eastern Hepatobiliary Hospital,Second Military Medical University,Shanghai 200438,China) |
| Abstract: |
| Objective:To observe the therapeutic effects of transcatheter arterial chemoembolization(TACE) on intrahepatic cholangiocarcinoma (ICC) patients who received surgical excision,so as to discuss whether TACE should be routinely used for ICC patients after surgical resection to prevent recurrence.Methods: The clinical data of 80 pathologically-confirmed ICC patients,who received surgical excision in our hospital from July,2005 to December,2005,were retrospectively analyzed.Thirty-six cases received TACE treatment after operation (group A),and the others did not receive TACE (group B).The general data and laboratory findings were compared between the two groups.The survival periods (six months,1 year,2 years and 3 years) of the patients were observed and statistically analyzed.The risk factors for survival were also analyzed.Results: There were no significant differences in sex,age,history of hepatitis B virus infection,liver cirrhosis,laboratory findings,including hepatitis B surface antigen,alpha-fetoprotein,carcinoembryonic antigen (CEA),CA19-9 (CA19-9),alanine aminotransferase and total bilirubin,tumor size,number of tumors,and hilar lymph node metastases(P>0.05).The half-year,1-year,2-year and 3-year survival rates in the two groups were 80.6% vs 81.8% (χ2= 0.082 2,P=0.774 4),63.9% vs 65.9% (χ2= 0.418 7,P=0.517 6),25.0% vs 22.7% (χ2= 0.118 7,P=0.730 5),and 8.3% vs 9.1% (χ2= 0.115 7,P=0.733 7),respectively.There were no significant differences between the two groups.COX regression analysis showed that CEA,CA19-9 and hilar lymph node metastasis were the independent risk factors of survival rate,with the coefficients being 2.930 (P=0.012 5),19.913 (P<0.001),and 17.791 (P<0.001),respectively.Postoperative TACE was not an independent factor of patient survival.Conclusion: Postoperative TACE may not improve the survival rate of ICC; therefore routine TACE should not be recommended for ICC patients after TACE to prevent possible recurrence. |
| Key words: liver neoplasms intrahepatic cholangiocarcinoma hepatectomy transcatheter arterial chemoembolization |
