目的 探讨肝内胆管癌(ICC)行手术治疗后影响患者生存的危险因素,并依据此构建列线图预测模型.方法 通过SEER*Stat软件从美国国立癌症研究所"监测、流行病学和结果数据库"(the Surveillance,Epidemiology,and End Re-sults,SEER)数据库获取2004-2015年诊断为ICC患者的临床病理资料信息共2 100例,通过R软件中"rms"包将筛选过后的临床病理资料随机分成建模组和验证组,两组人数分别为1 470例和630例,通过使用R软件进行单因素Cox回归分析,根据处理后的结果筛出可能与ICC患者生存相关的危险因素,再将得到的危险因素进行多因素Cox回归分析,基于多因素Cox回归分析的结果构建ICC患者的列线图,模型的预测能力通过受试者工作特征曲线(ROC曲线)、C-index、和校准曲线等方式进行验证.结果 建模组ICC患者的6、12和24月生存为分别为65.2％、47.5％和29.4％;验证组ICC的6、12和24月生存为分别为70.3％、51.3％和32.2％.多因素Cox分析显示年龄、性别、AJCC State Group分期、手术、肿瘤大小、化疗为影响ICC患者预后的危险因素,根据筛选出的6个独立危险因素所构建的预测模型,C-index为0.742(95％CI:0.729～0.757),建模组中患者6、12和24月的ROC曲线下面积分别为0.848、0.818和0.751.验证组据筛选出的6个独立危险因素所构建的预测模型,C-index为0.737(95％CI:0.715～0.760),验证组中患者6、12和24月的ROC曲线下面积分别为0.772、0.733和0.706.在两组队列中6、12和24月的校准曲线显示两个列线图的预测值和实际观察值高度一致.结论 通过筛选出的独立危险因素能够很好的预测ICC患者的预后,为临床工作个体化治疗提供参考依据.

Objective:To evaluate the application value of laparoscopic hydatid cyst punture drainage with Trocar for hepatic cystic echinococcosis.Methods:Clinical data of 20 patients with hepatic cystic echinococcosis treated with laparoscopic cyst punture drainage using disposable Trocar in Qinghai University Affiliated Hospital from January 2018 to January 2020 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 12 patients were male and 8 female, aged from 10 to 68 years, with a median age of 43 years. The hydatid cysts of 7 cases were located in the left lobe and 13 in the right lobe. 16 cases were with single lesion and 4 with multiple lesions. The median diameter of cysts was 10.3(1.0-18.2) cm. Under laparoscope, a 5-mm disposable Trocar was used to puncture the hydatid cysts through abdominal wall, and a common aspirator was inserted to discharge the cyst fluid for decompression. Hypertonic saline (20%) was injected through the Trocar inlet and soaked for 10 min. Different operations were performed on the patients according to different lesions. The operation results were observed.Results:The operations were completed successfully in all the patients without conversion to open surgery. Excision of internal capsule was performed in 9 cases, excision of internal capsule + dissection of partial external capsule in 6 cases, excision of internal capsule + dissection of partial external capsule + suture of bile leakage in 4 cases, multiple cyst resection in 1 case. Bile leakage occurred in 2 cases and residual cavity effusion in 2 cases after operation, and they were cured after drainage and anti-infection treatments. The remaining patients were properly recovered, and the drainage tube was removed after 3-7 d. The length of postoperative hospital stay was 7(3-12) d. During the postoperative follow-up for 3 months to 1 year, no recurrence or implantation metastasis was reported.Conclusions:Laparoscopic hydatid cyst punture drainage with Trocar for hepatic cystic echinococcosis is an effective, safe and convenient method, which can prevent the fluid leakage and reduce the recurrent risk.