Cholangiocarcinoma Risk as Long-term Outcome After Hepatic Resection in the Hepatolithiasis Patients
Cholangiocarcinoma Risk as Long-term Outcome After Hepatic Resection in the Hepatolithiasis Patients
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DOI：
10.1007/s00268-015-2965-0
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发表时间：
2015-06-01
影响因子：
2.6
通讯作者：
Bak, Young-Tae
中科院分区：
文献类型：
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作者：
Kim, Hyo Jung;Kim, Jae Seon;Bak, Young-Tae
背景肝内胆管结石是众所周知的胆管癌变的危险因素。尽管诊断方法有所进步，但对肝胆管结石患者胆管细胞癌的诊断仍然具有挑战性，关于肝胆管结石患者治疗后胆管细胞癌发生率的报道还不够多。目的探讨肝内胆管结石切除与未切除患者胆管癌变的发生率及临床特点。方法对257例肝内胆管结石患者的临床资料进行统计分析。排除标准为随访期<9个月、术前诊断为胆管细胞癌、治疗后1年内发生胆管细胞癌。当在整个随访期内无肝内胆管结石时，确定结石清除的完全性。对患者的特点、手术效果、并发症及远期疗效进行回顾性分析。结果肝切除术(切除组)95例，未切除组(未切除组)144例。切除术组结石完全排净率为71%(67/95)，未切除术组为41%(58/95)(P<0.001)。随访期(平均41+/-41个月)胆管癌发生率为6.8%(16/236)。切除组和未切除组胆管癌的发生率分别为6.3%(6/95)和7.1%(10/141)。两组患者的生存率差异无统计学意义(p=0.254)。在不同治疗方式的结石清除完全程度分析中，残留结石患者的胆管癌变率(10.4%)高于完全取石者(3.3%)(p=0.263)。多因素分析显示，年龄、性别、CA19-9、结石部位、胆管狭窄、肝萎缩、结石复发、残留结石、肝切除等因素与胆管癌的发生无明显关系。结论肝内胆管结石切除对预防胆管癌的价值有限，即使在肝切除后仍应密切关注。为了减少肝内胆管结石的残留，改善患者的预后，有必要结合不同的治疗方法。
Background Hepatolithiasis is a well-known risk factor of cholangiocarcinoma. Despite advances in diagnostic modalities, diagnosing cholangiocarcinoma in patients with hepatolithiasis still challenging and there are not enough reports on the incidence of cholangiocarcinoma in patient with hepatolithiasis after treatment. We aimed to evaluate the incidence and clinical characteristics of cholangiocarcinoma in patients with hepatolithiasis who underwent liver resection or non-resection.Methods Among a total of 257 patients who received treatment for hepatolithiasis, 236 patients were eligible for analysis. Exclusion criteria were follow-up period less than 9 months, preoperative diagnosis of cholangiocarcinoma, occurrence of cholangiocarcinoma within 1 year after treatment. Completeness of stone clearance was defined when there was no intrahepatic duct stone during whole follow-up period. A retrospective study was done to analyze the patients' characteristics, the results and complications of the procedure, and the long-term outcomes for these patients. Kaplan-Meier method and cox proportional regression were used for statistical analysis.Results 95 patients underwent hepatic resection (resection group) and 144 patients did not (non-resection group). Complete stone clearance was 71 % (67/95) in resection group and 41 % (58/141) in non-resection group (p\0.001). The incidence of cholangiocarcinoma was 6.8 % (16/236) during follow-up period (mean 41 +/- 41 months). Cholangiocarcinoma occurred 6.3 % (6/95) and 7.1 % (10/141) in resection and non-resection group, respectively. There was no significant difference in survival between two groups (p = 0.254). In analysis of according to completeness of stone clearance regardless of treatment modality, cholangiocarcinoma incidence was higher in patients with residual stone (10.4 %) than complete stone removal (3.3 %) (p = 0.263). On multivariate analysis, none of the factors (age, gender, CA19-9, stone location, bile duct stenosis, liver atrophy, stone recurrence, residual stone, and hepatic resection) showed relationship with the incidence of cholangiocarcinoma.Conclusion Hepatic resection for hepatolithiasis is considered to have a limited value in preventing cholangiocarcinoma and the patients should be carefully followed even after hepatic resection. A combination of different treatment modalities is necessary to decrease the residual stone and improve the outcome of the patients with hepatolithiasis.