| Objective:In this paper, we are going to summarize and discuss the preoperative evaluation, treatment strategy and influence factors of long-term survive by collecting the data of patients with hilar cholangiocarcinoma that were treated in our center in recent years and combining with relevant research results.Methods:According to the inclusion and exclusion criteria, we retrospectively analyze the data of 528 patients with hilar cholangiocarcinoma that were treated in our center from January,2008 to December,2013. They are divided into different groups by the treatment they were received, then analyze the difference between groups according to their general information, preoperative examinations, treatment results, prognosis, etc and combining with relevant literatures about the treatment strategy and prognostic influence factors of hilar cholangiocarcinoma.Results:In the 528 cases, the ratio of male to female is 1.65:1 and with a average age of (58.8±10.7) years old and their main clinical symptoms is painless jaundice. According to Bismuth-Corlette typing method, there are type Ⅰ in 22 cases, type Ⅱ in 70 cases, type Ⅲa in 112 cases, type Ⅲb in 191cases and type Ⅳ in 133 cases. And there were 327 cases combined with portal vein and (or) hepatic artery invasion according the results of preoperative imaging examination and confirming during operation. The ratio of vascular invasion reached 62%. Among the 528 patients,247 cases underwent radical resection,117 cases received palliative resection that including Rl resection in 71 cases and 46 cases in R2 resection, T tube drainage in 39 cases, intraoperative cholangiography with tube drainage in 14 cases, PTBD drainage in 47 cases, ENBD drainage in 6 cases and 58 cases received conservative treatment. The ratio of radical resection reached 46.8%. On the other hand, biliary fistula and intro-abdominal infection account for the main postoperative complications and the incidence of complications was 28.3%, the mortality rate was 5.1%. In this group of patients,431 cases were fellowed up and the fellowed-up rate was 81.6%. The median survival time was 25 months and the one-, three-, five-year survival rate was 77.1%,30.8%,13.9% respectively in the overall group. While the median survival time was 33 months and the one-, three-, five-year survival rate was 91.6%,49.3%,27.8% respectively in the group of radical resection, and the difference in survival time between groups has statistically significant (X 2=22.061, P=0.000). We analyze the possible factors that may affect the prognosis of patients with HC through single factor analysis, the result suggested the treatment strategy, tumor differentiation, lymph nodes metastasis, peri-neural invasion, vascular invasion and the volume of intraoperative bleeding were the risk factors that influence the prognosis of patients with HC. Then we did further multi-factors analysis by Cox regression model, the result showed that the treatment strategy, tumor differentiation, lymph nodes metastasis, peri-neural invasion, vascular invasion were the independent risk factors that affect the prognosis of patients with HC.Conclusions:1) Radical resection is the best treatment method for patients with HC to get better prognosis. We should avoid sightless operative resection and do some drainage therapy for those patients who were unable to achieve radical resection.2) Careful preoperative evaluation and surgical planning could not only improve the radical resection rate of HC, reduce the incidence of postoperative complications and mortality,but also improve patients’further survival rate.3) Treatment strategy, tumor differentiation, lymph nodes metastasis, peri-neural invasion, vascular invasion were the independent risk factors that affect the prognosis of patients with HC. |
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