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目的：探讨中下段胆管癌的预后影响因素。方法：对79 例中下段胆管癌患者的临床资料进行回顾性分析，采用 Kaplan-Meier分析对确定的单因素进行生存率的描述，用Cox回归进行多因素分析，采用log-rank法对单因素进行生存分析评价。结果：79例患者1 、3 、5年生存率分别为70.2%，36.2%，19.1%，中位生存时间为19.8个月。行根治性手术患者1 年、3年、5 年生存率分别为87.9%、45.5%和24.2%，分别显著高于姑息性手术患者1 年、3 年、5 年生存率（28.9%、14.3%和7.1%）；行根治性手术患者的中位生存时间为34.5 个月，较姑息性手术患者显著延长(8 个月)，根治术与姑息性手术1、3、5 年生存率及中位生存时间比较四项均P<0.01，差异具有统计学意义。单因素分析显示肿瘤病理分化，慢性病史，淋巴结转移为影响中下段胆管癌预后的因素。多因素分析显示慢性病史、手术切缘、肿瘤病理分化程度是影响中下段胆管癌预后的独立危险因素。结论：慢性病史、手术切缘、肿瘤病理分化程度为中、下段胆管癌行切除术后预后的独立危险因素，根治性手术可提高中、下段胆管癌患者的生存率和延长其生存时间。

英文摘要:

Objective: To investigate the prognostic factors of middle and distal bile duct carcinoma. Methods: A retrospective clinical analysis was made on 79 cases of middle and distal bile duct carcinoma. Clinicopathologic factors with possible prognostic significances were selected and analyzed. Survival was calculated with the Kaplan-Meier method. A multivariate analysis of these individuals was performed using the Cox proportional Hazards Model. Results: The 1-,3-,and 5-year survival rates were 70.2%, 36.2%， 19.1% respectively, and the median survival time was 19.8 months. Radical resection was performed on 53 cases and palliative operation was performed on 14 cases. The 1-,3-,and 5-year survival rates were 87.9% vs 28.9%(P<0.01), 45.5% vs 14.3%(P<0.01) and 24.2% vs 7.1%(P<0.01) respectively, and the median survival time was 19.8 vs 8 months (P<0.01). The statistical analysis showed that chronic disease, histopathological grade and lymph node metastasis affected postoperative survival significantly. In multivariate analysis, chronic disease, histopathological grade and surgical margin status were significant independent prognostic factors. Conclusions: Radical resection is an important strategy to improve the long-survival of postoperative patients in middle and distal bile duct carcinoma. Chronic disease, histopathological grade and surgical margin status were significant independent prognostic factors.

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