胆囊癌外科治疗预后影响因素分析  

Predictive factors for surgical treatment of gallbladder carcinoma

作　　者：孟宪魁[1] 张雷[1] 

机构地区：[1]西安交通大学医学院第一附属医院老年外科,陕西西安710061

出　　处：《现代肿瘤医学》2013年第7期1567-1570,共4页Journal of Modern Oncology

摘　　要：目的:外科治疗是胆囊癌唯一有效治疗方法,但预后仍不令人满意。本文分析我院胆囊癌外科治疗资料,总结影响胆囊癌术后生存的主要因素。方法:收集并分析于2005-2009年在我院肝胆外科和老年外科接受外科治疗的胆囊癌患者围手术期和预后资料,分析影响患者术后生存期的因素。结果:在123例胆囊癌患者中,实施单纯胆囊切除术12例,标准根治性胆囊癌根治术44例,扩大胆囊癌根治术25例,姑息性切除19例,姑息性胆道引流术17例,单纯腹腔活检术6例。术后随访率81.3%,随访时间中位数为30个月。本组胆囊癌患者围手术期死亡率7.3%,术后3年生存率34.1%,术后5年生存率11.4%。单因素分析发现联合局部肝脏切除、R0级根治术、肝十二指肠韧带内淋巴结清扫、TNM分期均影响患者术后的生存期。多因素分析证实联合局部肝脏切除、R0级根治和TNM分期是影响术后生存的独立因素。结论:联合局部肝脏切除、R0级根治术、肝十二指肠韧带内淋巴结清扫、TNM分期是影响胆囊癌患者预后的主要因素。早期发现胆囊癌(较早的TNM分期),并给予联合局部肝脏组织切除和肝十二指肠韧带内淋巴结清扫的胆囊癌根治术可以明显改善早期胆囊癌患者预后。Objective：Although surgical resection is a radical treatment option for gallbladder carcinoma（GBC）,it remains difficult to cure and patient prognosis is poor.To investigate the factors contributing to the post-surgical survival of patients with GBC,we analyzed the clinical data of GBC patients receiving surgical treatment in our hospital during a 4-year period.Methods：The clinical data of 123 GBCs admitted in Department of Hepatobiliary Surgery and Geratic Surgery,the First Affiliated Hospital,School of Medicine,Xian Jiaotong Univeristy from 2005-2009 were collected and anaylzed retrospectively to find out the factors influencing surgical outcome.Results： Among 123 cases of GBC,12 patients had received simple cholecystectomy,44 cases were given radical cholecystectomy,25 cases underwent extended procedures,19 cases received palliative resection,17 cases received palliative bile duct drainage and simple abdomen biopsy.81.3% of patients received follow-up after operation,and the median follow-up period was 30 months.The operative mortality（one month after operation）were 3.3% and the 3-year survival rate was 34.1%,the 5-year survival rate was 11.4%.Univariate analysis revealed that predictive factors of improved prognosis included liver resection,R0 curative resection,hepatoduodenal nodal clearance and early TNM staging.Further,liver resection,R0 curative resection and early TNM staging were verified to be significantly associated with promosing survival dependently as analyzed by COX multivariate analysis.Conclusion：Predictive factors including liver resection,R0 curative resection,hepatoduodenal nodal clearance and early TNM staging affect the postsurgical outcome of GBC.Diagnosis and radical cholecystectomy at the early stage could improve prognosis of GBC dramatically.

关 键 词：胆囊癌 外科治疗 术后生存期 影响因素 

分 类 号：R735.8[医药卫生—肿瘤]