【摘要】：[目的]:探究和探討遠(yuǎn)端膽管癌在行胰十二指腸切除術(shù)后腫瘤復(fù)發(fā)的危險(xiǎn)因素,進(jìn)一步為臨床治療提供參考。本課題將更為全面的從患者術(shù)前因素、手術(shù)因素、腫瘤病理因素、術(shù)后因素四方面的多個(gè)因素來研究分析影響遠(yuǎn)端膽管癌術(shù)后復(fù)發(fā)的危險(xiǎn)因素。從而更好的評(píng)估膽總管遠(yuǎn)端癌行根治手術(shù)的預(yù)后,更好的為患者選擇適合的手術(shù)或治療方法,以保證患者生存質(zhì)量。[方法]:回顧性分析2009年1月至2015年1月于昆明醫(yī)科大學(xué)第二附屬醫(yī)院肝膽胰外科一病區(qū)診斷為膽總管遠(yuǎn)端癌,并行胰十二指腸根治性切除的73例患者的臨床資料。以患者術(shù)后兩年內(nèi)是否復(fù)發(fā)為依據(jù)將患者分為復(fù)發(fā)組和未復(fù)發(fā)組,將兩組進(jìn)行對(duì)比研究,分析可能影響復(fù)發(fā)的因素。分類變量和連續(xù)變量分別采用獨(dú)立樣本的X2檢驗(yàn)和t檢驗(yàn),篩選出與術(shù)后復(fù)發(fā)有關(guān)的危險(xiǎn)因素。Logstic回歸模型對(duì)所篩選出的危險(xiǎn)因素進(jìn)行多因素分析,從而確定影響遠(yuǎn)端膽管癌行行胰十二指腸切除術(shù)后復(fù)發(fā)的獨(dú)立危險(xiǎn)因素。[結(jié)果]:隨訪的73例患者中,圍手術(shù)期死亡患者2例,死亡率為2. 7%。剩余71例患者中術(shù)后兩年內(nèi)復(fù)發(fā)21例,未復(fù)發(fā)50例,復(fù)發(fā)率為29. 5%。獨(dú)立樣本統(tǒng)計(jì)分析示:術(shù)前白蛋白(P=0. 036 )、術(shù)中輸血(P=0. 032 )、胰腺侵犯(P=0. 032 )、淋巴結(jié)轉(zhuǎn)移(P0.01)、淋巴結(jié)轉(zhuǎn)移比(P0.01)、腫瘤分化情況(P=0.017)、TNM分期(P0. 01)是影響遠(yuǎn)端膽管癌患者行胰十二指腸切除術(shù)后腫瘤復(fù)發(fā)的危險(xiǎn)因素。Logstic多因素回歸模型分析示:術(shù)前白蛋白水平(0.005)、腫瘤分化情況(P=0. 007)是影響腫瘤術(shù)后復(fù)發(fā)的獨(dú)立危險(xiǎn)因素。[結(jié)論1 :遠(yuǎn)端膽管癌患者中,男性較女性多發(fā)。其病理類型以腺癌多見。術(shù)前白蛋白水平、術(shù)中輸血、胰頭轉(zhuǎn)移、淋巴結(jié)轉(zhuǎn)移、淋巴結(jié)轉(zhuǎn)移比、腫瘤分化情況、腫瘤TNM分期是影響遠(yuǎn)端膽管癌患者行胰十二指腸切除術(shù)后腫瘤復(fù)發(fā)的相關(guān)因素。其中術(shù)前白蛋白水平和腫瘤分化情況是影響遠(yuǎn)端膽管癌胰十二指腸術(shù)后復(fù)發(fā)的獨(dú)立危險(xiǎn)因素
[Abstract]:Objective: to explore the risk factors of tumor recurrence after pancreaticoduodenectomy for distal cholangiocarcinoma. This study will analyze the risk factors affecting the recurrence of distal cholangiocarcinoma from four factors: preoperative factors, surgical factors, tumor pathological factors and postoperative factors. Thus better evaluation of the prognosis of distal choledochus cancer radical surgery, better choice of surgery or treatment for patients, in order to ensure the quality of life of patients. [methods] the clinical data of 73 patients with distal choledochal carcinoma diagnosed in the Department of Hepatobiliary and Pancreatic surgery of the second affiliated Hospital of Kunming Medical University from January 2009 to January 2015 were retrospectively analyzed. The patients were divided into recurrence group and non-recurrence group according to whether the patients recurred within two years after operation. The two groups were compared to analyze the factors that might affect the recurrence. The risk factors associated with postoperative recurrence were screened by X _ 2 test and t test of independent samples, respectively. The risk factors were analyzed by logistic regression model. To determine the risk factors for recurrence of distal cholangiocarcinoma after pancreaticoduodenectomy. [results]: of the 73 patients followed up, 2 died during the perioperative period, with a mortality rate of 2. 5%. Seven. Among the remaining 71 cases, 21 cases recurred within two years after operation, 50 cases did not relapse, the recurrence rate was 29.9%. Five. The statistical analysis of independent sample showed that preoperation albumin (P0. 0. , intraoperative blood transfusion (P0. 0. , pancreatic invasion (P < 0.01), pancreatic invasion (P < 0.05), pancreatic invasion (P < 0.05). Lymph node metastasis (P0.01), lymph node metastasis ratio (P0.01), tumor differentiation (P0. 017) and TNM stage (P0. 01). 01) was a risk factor for tumor recurrence after pancreaticoduodenectomy in patients with distal cholangiocarcinoma. Logistic multivariate regression analysis showed that: preoperative albumin level (0.005), tumor differentiation (P0. 0). 007) is an independent risk factor for tumor recurrence after operation. Conclusions 1: in patients with distal cholangiocarcinoma, males are more frequent than females. Adenocarcinoma is the most common pathological type. Preoperative albumin level, intraoperative blood transfusion, pancreatic head metastasis, lymph node metastasis, tumor differentiation and tumor TNM staging were related factors for tumor recurrence after pancreaticoduodenectomy in patients with distal cholangiocarcinoma. The preoperative albumin level and tumor differentiation were independent risk factors for the recurrence of distal cholangiocarcinoma after pancreaticoduodenectomy.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.8

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 胡勛;李生偉;;肝門部膽管癌的外科診治進(jìn)展[J];醫(yī)療裝備;2016年20期

2 范懷衛(wèi);楊曉明;楊向東;;中下段膽管癌切除術(shù)后切緣陽性的意義分析[J];湖南師范大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2016年04期

3 馬婉紅;;血清CA199和CEA聯(lián)合檢測(cè)對(duì)膽管癌的診斷價(jià)值分析[J];臨床醫(yī)藥文獻(xiàn)電子雜志;2016年03期

4 ;膽管癌診斷與治療——外科專家共識(shí)[J];臨床肝膽病雜志;2015年01期

5 曾泓澤;易航;胡兵;;ERCP/PTCD在惡性梗阻性黃疸術(shù)前膽管引流中的應(yīng)用[J];肝膽外科雜志;2014年06期

6 徐藝;王浩;崔云甫;;遠(yuǎn)端膽管癌的治療進(jìn)展[J];世界華人消化雜志;2014年28期

7 宋惠雯;蔣義貴;張生君;尤麗財(cái);萬土兒;張玲麗;;血清CA199與膽管結(jié)石及膽管炎的關(guān)系[J];胃腸病學(xué)和肝病學(xué)雜志;2013年12期

8 卡哈爾·吐爾遜;吳源泉;王曉嶸;白磊;買買提吐爾孫·吐爾迪;趙晉明;;保留幽門的胰十二指腸切除術(shù)與胰十二指腸切除術(shù)治療壺腹周圍癌及胰頭癌的Meta分析[J];中國普通外科雜志;2013年09期

9 王越;O次捌，

本文編號(hào)：2215288