肝胆管结石进展肝内胆管癌的危险因素研究

摘要/Abstract

摘要： 目的: 探讨肝胆管结石进展为肝内胆管癌(ICC)的危险因素。方法: 纳入我院2017年11月—2019年11月宿州市第一人民医院收治的肝胆管结石患者150例,收集患者的临床资料,根据其是否进展为ICC,分为ICC组、非ICC组。比较两组临床特征,经logistic回归模型分析肝胆管结石进展为ICC的多因素。结果: 在纳入的150例患者中,39例(26.00%)进展为ICC,111例(74.00%)未进展为ICC。ICC组胆肠吻合术史、肝硬化、肝胆管结石病程≥10年、糖尿病占比显著高于非ICC组,而结石彻底清除占比显著低于非ICC组(P<0.05)。Logistic回归模型显示,胆肠吻合术史、肝硬化、肝胆管结石病程≥10年、糖尿病是肝胆管结石进展为ICC的危险因素(P<0.05),结石彻底清除是预防其进展为ICC的保护性因素(P<0.05)。结论: 肝胆管结石进展为ICC与多种因素有关,主要包括胆肠吻合术史、肝硬化、肝胆管结石病程、糖尿病,而彻底清除结石能降低ICC发生风险。

关键词: 肝胆管结石, 肝内胆管癌, 胆肠吻合术史, 肝硬化, 危险因素

Abstract: Objective To explore the risk factors for the progression of hepatolithiasis to intrahepatic cholangiocarcinoma (ICC). Methods 150 patients with hepatolithiasis admitted to our hospital from November 2017 to November 2019 were included. The clinical data of the patients were collected and divided into ICC group and non ICC group according to their progress to ICC. By comparing the clinical characteristics of the two groups, the logistic regression model was used to analyze the multiple factors that lead to ICC. Results Of the 150 participants, 39 (26.00%) developed ICC and 111 (74.00%) did not. In ICC group, the history of choledochojejunostomy, the course of cirrhosis, hepatolithiasis ≥ 10 years, the proportion of diabetes was significantly higher than that in non ICC group, while the proportion of complete stone removal was significantly lower than that in non ICC group (P<0.05).Logistic regression model showed that the history of choledochojejunostomy, cirrhosis, the course of hepatolithiasis ≥ 10 years, diabetes mellitus were the risk factors for the progression of hepatolithiasis to ICC (P<0.05), and the complete removal of stones was the protective factor to prevent the progression to ICC (P<0.05). Conclusion The progression of hepatolithiasis to ICC is related to a variety of factors, including the history of choledochojejunostomy, cirrhosis, the course of hepatolithiasis, diabetes, and thorough removal of stones can reduce the risk of ICC.

Key words: Hepatolithiasis, Intrahepatic cholangiocarcinoma, History of choledochojejunostomy, Cirrhosis, Risk factors

牛腾腾, 张贡献, 陈宝华, 王震. 肝胆管结石进展肝内胆管癌的危险因素研究[J]. 肝脏, 2020, 25(7): 705-708.

NIU Teng-teng, ZHANG Gong-xian, CHEN Bao-hua, WANG Zhen. Study on the risk factors of hepatolithiasis developing intrahepatic cholangiocarcinoma[J]. Chinese Hepatolgy, 2020, 25(7): 705-708.

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