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目的 :探讨中下段胆管癌切除术后切缘阳性的意义。方法 :回顾性分析在本院住院治疗的中下段胆管癌患者70例,以术后是否复发分组进行影响患者术后复发的各项因素单因素和多因素分析;对不同切缘患者的生存时间进行分析。结果 :术后随访有28例患者复发,复发率为40%。单因素分析结果显示:术前引流的患者复发率(47.27%)高于未做术前引流的患者(13.33%),有浸润的患者复发率(62.07%)高于无浸润的患者(24.39%),病理高分化的患者复发率(55.56%)高于非高分化的患者(13.33%),切缘R1的患者复发率(83.33%)高于切缘R0的患者(31.03%),淋巴结转移的患者复发率(72.22%)高于无淋巴结转移的患者(25.85%);多因素分析结果显示:术前引流、浸润型、切缘R1、淋巴结转移是胆管癌术后复发的主要危险因素。切缘为R0的患者5年随访期中位复发时间22个月显著的高于切缘为R1的患者的15个月。切缘为R0的患者5年随访期中位生存时间36个月显著的高于切缘为R1的患者的33个月。结论 :术前引流、浸润型、切缘R1、淋巴结转移是中下段胆管癌切除术后复发的危险因素,切缘为R0的患者的生存时间高于切缘为R1的患者。
Objective: To investigate the significance of positive margins after resection of middle and lower cholangiocarcinoma. Methods: A retrospective analysis of 70 hospitalized patients with cholangiocarcinoma in the middle and lower stages of hospitalized patients with postoperative recurrence group affected the factors of postoperative recurrence in patients with univariate and multivariate analysis of factors; survival of patients with different margins Analyze. Results: Follow-up 28 patients relapsed after surgery, the recurrence rate was 40%. The results of univariate analysis showed that the recurrence rate was significantly higher in patients with preoperative drainage (47.27%) than those without drainage (13.33%), and those with infiltration (62.07%) were higher than those without infiltration (24.39% (55.56%) was higher than that of non-differentiated patients (13.33%). The recurrence rate of patients with R1 (83.33%) was higher than that of patients with R0 (31.03%). The lymph node metastasis (72.22%) were higher than those without lymph node metastasis (25.85%). Multivariate analysis showed that preoperative drainage, infiltrating type, marginal edge R1 and lymph node metastasis were the main risk factors for postoperative recurrence of cholangiocarcinoma. The median recurrence time at 5-year follow-up was 22 months in patients with R0 margins significantly higher than those in patients with R1 at 15 months. Patients with R0 margins had a median survival time of 36 months at the 5-year follow-up of 33 months, significantly higher than patients with R1 margins. CONCLUSION: Preoperative drainage, infiltration, margins R1 and lymph node metastasis are risk factors for recurrence of cholangiocarcinoma in the middle and lower segments. The survival time of patients with R0 margins is higher than that of patients with the margins of R1.