Objective: To clarify whether the surgical treatment for hilar cholangiocarcinoma combined with artery reconstruction is optimistic to the patients with hilar cholangiocarcinoma with hepatic artery invasion. Methods: There were 384 patients who received treatment in the First Affiliated Hospital to Army Medical University from January 2008 to January 2016 analyzed retrospectively. There were 27 patients underwent palliative operation, 245 patients underwent radical operation, radical resection account for 63.8%. Patients were divided into four groups according to different operation method: routine radical resection group(n=174), portal vein reconstruction group (n=47), hepatic artery reconstruction group (n=24), palliative group(n=27). General information of patients who underwent radical operation treatment was analyzed by chi-square test and analysis of variance. The period of operation time, blood loss, the length of hospital stay and hospitalization expenses of the radical operation patients were analyzed by one-way ANOVA. Comparison among groups was analyzed by LSD-t test. Results: The follow-up ended up in June first, 2016. Each of patients followed for 6 to 60 months, the median follow-up period was 24 months. 1-, 3-, and 5-year survival rates were 81.3%, 44.9% and 13.5% of routine radical operation group, and were 83.0%, 44.7% and 15.1% of portal vein reconstruction group, and were 70.8%, 27.7% and 6.9% of hepatic artery reconstruction group, respectively. And 1-, 3-, and 5-year survival rates of hepatic artery reconstruction group was lower than routine radical group and portal vein reconstruction group significantly (P<0.05). However, the rate of postoperative complications of the hepatic artery reconstruction group and the routine radical operation group and the portal vein reconstruction group were 62.5%(15/24), 55.3%(96/174) and 51.5%(24/47), respectively. There was no significant difference among them (P>0.05). The data shows that the ratio of lymphatic metastasis in hepatic artery reconstruction group (70.8%) is much higher than them in routine radical operation group (20.1%) and portal vein reconstruction group (19.1%) significantly (P<0.05). The presented data also indicate that hepatic artery resection prolongs survival time comparing with patients undergoing palliative therapy for hilar cholangiocarcinoma. Cox regression analysis indicate that hepatic artery resection and reconstruction is a protective factor compare with palliative therapy (RR=0.38, 95%CI: 0.22-0.67). The significant reason for shorter survival time is a positive correlation between hepatic artery invasion and lymph node metastasis. Conclusion: Hepatic artery resection and reconstruction has beneficial impact on oncologic long-term outcome in patients with advanced stage hilar cholangiocarcinoma.
目的： 探讨肝动脉受侵犯的肝门部胆管癌患者行联合肝动脉切除重建的肝门部胆管癌根治术对预后的影响。 方法： 回顾性收集2008年1月至2016年1月陆军军医大学第一附属医院(原第三军医大学第一附属医院)收治的384例肝门部胆管癌患者资料。姑息性手术27例，根治性手术245例，根治性切除率为63.8%。根据手术方式不同分为四组：常规根治组(174例)、门静脉重建组(47例)、肝动脉重建组(24例)和姑息手术组(27例)。根治性手术患者一般资料的比较采用卡方检验或方差分析法。采用单因素方差分析比较三组患者手术时间、术中出血量、住院时间和住院费用的情况，用LSD t法进行组间两两比较。 结果： 随访截至2016年6月1日，所有患者经过6～60个月的随访观察，中位随访时间为24个月。常规根治组的1、3、5年生存率分别为81.3%、44.9%、13.5%，门静脉重建组为83.0%、47.1%、15.1%，肝动脉重建组为70.8%、27.7%、6.9%。而肝动脉重建组患者1、3、5年生存率低于门静脉重建组与常规根治组(P<0.05)。肝动脉重建组、常规根治组和门静脉重建组患者术后并发症发生率分别为62.5%(15/24)、55.3%(96/174)和51.1%(24/47)，差异均无统计学意义(P>0.05)。肝动脉重建组(70.8%)患者淋巴结转移比例较常规根治组(20.1%)和门静脉重建组(19.1%)高(P值均<0.05)。肝动脉重建组患者术后生存时间高于姑息手术组，Cox回归提示联合肝动脉重建相对姑息手术是患者的保护因素(RR＝0.38，95%CI：0.22～0.67，P<0.05)。 结论： 在医患沟通良好的前提下，联合肝动脉切除重建对进展期肝门部胆管癌患者有积极的临床意义。.
Keywords: Hilar cholangiocarcinoma; Surgical treatment; Vascular resection and reconstruction.