Surgery:肝门部胆管癌患者不应常规行门静脉切除

2015-10-20 Mechront 译 MedSci原创

对肝门部胆管癌(HCA)行肝切除术 (LR)依旧存在很多挑战,因为血管和单管的侵犯是无法预料的。手术的目标之一是达到切缘无肿瘤浸润,而常规门静脉切除术(PVR) 对患者的利弊一直饱受争议。研究者纳入了60例行了LR的HCA病例。其中有21(35.0%)名病人进行了LR+PVR,余下39(65.0%)名病人只行了LR。研究者通过单因素和多因素分析对数据进行处理。研究结果显示,切除术主要针对的是Bis

对肝门部胆管癌(HCA)行肝切除术 (LR)依旧存在很多挑战,因为血管和胆管的侵犯是无法预料的。手术的目标之一是达到切缘无肿瘤浸润,而常规门静脉切除术(PVR) 对患者的利弊一直饱受争议。

研究者纳入了60例行了LR的HCA病例。其中有21(35.0%)名病人进行了LR+PVR,余下39(65.0%)名病人只行了LR。研究者通过单因素和多因素分析对数据进行处理。

研究结果显示,切除术主要针对的是Bismuth-Corlette III / IV型肿瘤(97.3%)。41(68.3%)名患者进行了肝三分法切除。切缘肿瘤状态RI定义为对生存的有不良预后因素(HR 3.61; P = .003)。PVR增加了围手术期发病率风险(P = .04)。两组患者术后90天的发病率相比无统计学差异(P = .70)。淋巴结清楚情况在两组中也差不多(P = .86)。研究者还发现,PVR并不会对长期预后产生有利的影响,两组5年生存率比较:LR  17.8% vs LR + PVR 20.0% (P = .89);无病存活率比较: LR 10.6% vs LR + PVR 21.4% (P = .63)。PVR不是肿瘤相关生存率或无病存活率的预测因子(HR 0.64; P = .26/HR 0.76; P = .47)。

研究结果表明,对肝门部胆管癌患者进行肝切除术同时行门静脉切除术,不会对患者的长期预后产生有利影响,并且会导致围手术期发病率增加。因此门静脉切除术不能作为常规手术选择。

原始出处:

Hoffmann K, Luible S,et al.Impact of portal vein resection on oncologic long-term outcome in patients with hilar cholangiocarcinoma.Surgery. 2015 Nov;158(5):1252-60.

 

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    2016-07-05 chg121
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createdTime=Wed Dec 30 12:50:00 CST 2015, time=2015-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=49821, encodeId=39d849821b2, content=不错哦, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRiaKicWybj5Q5KN7PWibALciaJ4W5bZwTlDSFRibFu87125pCq0IXePrC0mpbiasADRqL4NcjUoyQCT9De/0, createdBy=7c7e1636498, createdName=wzf990214, createdTime=Mon Dec 28 06:28:00 CST 2015, time=2015-12-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=49822, encodeId=6d234982249, content=赞一个, beContent=null, objectType=article, channel=null, level=null, likeNumber=121, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, 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style='color:#2F92EE;'>#门静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97149, encryptionId=6d779e14916, topicName=门静脉)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Thu Oct 22 13:21:00 CST 2015, time=2015-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510539, encodeId=3dcf151053973, content=<a href='/topic/show?id=589b815113c' target=_blank style='color:#2F92EE;'>#肝门部胆管癌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81511, encryptionId=589b815113c, topicName=肝门部胆管癌)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5cae10200112, createdName=小刀医生, createdTime=Thu Oct 22 13:21:00 CST 2015, time=2015-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1628255, encodeId=9ac81628255c8, content=<a href='/topic/show?id=9a4e83503e4' target=_blank style='color:#2F92EE;'>#胆管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83503, encryptionId=9a4e83503e4, topicName=胆管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c21721182790, createdName=cmj15wellington, createdTime=Thu Oct 22 13:21:00 CST 2015, time=2015-10-22, status=1, ipAttribution=)]
    2015-12-30 xyfg98

    0

  5. 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style='color:#2F92EE;'>#门静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97149, encryptionId=6d779e14916, topicName=门静脉)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Thu Oct 22 13:21:00 CST 2015, time=2015-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510539, encodeId=3dcf151053973, content=<a href='/topic/show?id=589b815113c' target=_blank style='color:#2F92EE;'>#肝门部胆管癌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81511, encryptionId=589b815113c, topicName=肝门部胆管癌)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5cae10200112, createdName=小刀医生, createdTime=Thu Oct 22 13:21:00 CST 2015, time=2015-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1628255, encodeId=9ac81628255c8, content=<a href='/topic/show?id=9a4e83503e4' target=_blank style='color:#2F92EE;'>#胆管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83503, encryptionId=9a4e83503e4, topicName=胆管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c21721182790, createdName=cmj15wellington, createdTime=Thu Oct 22 13:21:00 CST 2015, time=2015-10-22, status=1, ipAttribution=)]
    2015-12-28 wzf990214

    不错哦

    0

  6. 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style='color:#2F92EE;'>#门静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97149, encryptionId=6d779e14916, topicName=门静脉)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Thu Oct 22 13:21:00 CST 2015, time=2015-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510539, encodeId=3dcf151053973, content=<a href='/topic/show?id=589b815113c' target=_blank style='color:#2F92EE;'>#肝门部胆管癌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81511, encryptionId=589b815113c, topicName=肝门部胆管癌)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5cae10200112, createdName=小刀医生, createdTime=Thu Oct 22 13:21:00 CST 2015, time=2015-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1628255, encodeId=9ac81628255c8, content=<a href='/topic/show?id=9a4e83503e4' target=_blank style='color:#2F92EE;'>#胆管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83503, encryptionId=9a4e83503e4, topicName=胆管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c21721182790, createdName=cmj15wellington, createdTime=Thu Oct 22 13:21:00 CST 2015, time=2015-10-22, status=1, ipAttribution=)]
    2015-12-28 wzf990214

    赞一个

    0

  7. 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style='color:#2F92EE;'>#门静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97149, encryptionId=6d779e14916, topicName=门静脉)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Thu Oct 22 13:21:00 CST 2015, time=2015-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510539, encodeId=3dcf151053973, content=<a href='/topic/show?id=589b815113c' target=_blank style='color:#2F92EE;'>#肝门部胆管癌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81511, encryptionId=589b815113c, topicName=肝门部胆管癌)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5cae10200112, createdName=小刀医生, createdTime=Thu Oct 22 13:21:00 CST 2015, time=2015-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1628255, encodeId=9ac81628255c8, content=<a href='/topic/show?id=9a4e83503e4' target=_blank style='color:#2F92EE;'>#胆管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83503, encryptionId=9a4e83503e4, topicName=胆管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c21721182790, createdName=cmj15wellington, createdTime=Thu Oct 22 13:21:00 CST 2015, time=2015-10-22, status=1, ipAttribution=)]
    2016-02-26 fusion
  8. 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  9. 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  10. 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