原发性胆囊癌根治术的临床疗效及预后分析  

Clinical effects and prognostic analysis of radical surgery for primary gallbladder cancer

作　　者：陈晨[1] 张东[1] 王林[1] 王作仁[1] 石磊[1] 陶杰[1] 白纪纲[1] 张瑞[1] 李起 李文智[1] 刘德春[1] 刘青光[1] 耿智敏[1] Chen Chen;Zhang Dong;Wang Lin;Wang Zuoren;Shi Lei;Tao Jie;Bai Jigang;Zhang Rui;Li Qi;Li Wenzhi;Liu Dechun;Liu Qingguang;Geng Zhimin(Department of Hepatobiliary Surgery,the First Affiliated Hospital,Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院肝胆外科,710061

出　　处：《中华消化外科杂志》2019年第2期128-134,共7页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金(81572420);陕西省重点研发计划(2017ZDXM-SF-055).

摘　　要：目的探讨原发性胆囊癌根治术的临床疗效及预后影响因素。方法采用回顾性病例对照研究方法。收集2013年至2017年西安交通大学第一附属医院收治的305例行原发性胆囊癌根治术患者的临床病理资料;男108例,女197例;中位年龄为62岁,年龄范围为30~88岁。根据不同肿瘤分期施行相应手术。术后根据化疗指征施行辅助治疗。观察指标:(1)影像学和实验室检查结果。(2)治疗情况:①手术治疗。②术后辅助治疗。(3)术后病理学检查结果。(4)随访情况。(5)影响术后预后的因素分析。采用门诊或电话方式进行随访,以死亡为终点,了解患者生存情况,随访时间截至2018年12月5日。正态分布的计量资料以Mean+_SD表示,偏态分布的计量资料以M(范围)表示,计数资料以百分比表示。使用Kaplan-Meier法绘制生存曲线计算生存率。单因素生存分析采用Log-rank检验。多因素分析采用COX回归模型。结果(1)影像学和实验室检查结果。影像学检查结果显示:超声、CT、MRI检查诊断率分别为84.06%(174/207)、85.71%(168/196)、63.11%(65/103)。实验室检查结果显示:CAl9.9、CAl25、CEA阳性率分别为55.34%(145/262)、48.06%(124/258)、46.15%(126/273)。(2)治疗情况。①手术治疗:305例患者均行胆囊癌根治术,其手术方式为肝楔形切除+D,淋巴结清扫术145例,肝楔形切除+D,淋巴结清扫术61例,肝1VB段及肝V段切除+D,淋巴结清扫术55例,肝ⅣB段及肝V段切除+D,淋巴结清扫术11例,右半肝切除+D,淋巴结清扫术9例,肝楔形切除+D,淋巴结清扫+结肠部分切除术5例,胰十二指肠切除术4例,Tis期行单纯胆囊切除术3例,右半肝切除+D,淋巴结清扫术3例,肝ⅣB或肝V段切除+D,淋巴结清扫+结肠部分切除术2例,肝ⅣB段及肝V段切除+门静脉切除重建+D,淋巴结清扫术、肝IVB段或肝V段切除+D,淋巴清扫+胃或十二指肠部分切除术、胰十二指肠切除+门静脉切除重建术、右半肝�Objective To investigate the clinical effects and prognostic factors of radical surgery for primary gallbladder cancer (GBC).Methods The retrospective case-control study was conducted.The clinicopathologieal data of 305 patients with primary GBC who underwent radical Ro resection in the First Affiliated Hospital of Xi'an Jiaotong University from 2013 to 2017 were collected,including 108 males and 197 females, aged from 30 to 88 years,with a median age of 62 years.According to the different tumor staging,patients underwent corresponding operation and adjuvant treatment based on the postoperative indication of chemotherapy. Observation indicators:(1)results of imaging and laboratory examinations;(2)treatment situations:①surgical situations,②postoperative adjuvant treatment;(3)results of postoperative pathological examination;(4)follow-up;(5)prognostic factors analysis.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival up to December 5,2018,and death was used as the end point.Measurement data with normal distribution were represented as Mean+-SD.Measurement data with skewed distribution were described as M (range).Count data were represented as percentage.The survival curve and survival rate were respectively drawn and calculated using the Kaplan-Meier method.The univariate analysis and multivariate analysis were respectively done using the Log-rank test and COX regression model.Results (1)Results of imaging and laboratory examinations:results of imaging examination showed that diagnostic rates of ultrasound,CT and MRI examination were respectively 84.06%(174/207),85.71%(168/196)and 63.11%(65/103).Results of laboratory examination showed that the positive rates of CA19-9,CA125 and carcinoembryonic antigen (CEA) were respectively 55.34%(145/262),48.06%(124/258)and 46.15%(126/273).(2)Treatment situations: ①surgical situations:305 patients underwent radical R0 resection for primary GBC,including 145 undergoing liver wedge resection +D2 lymph node dissecti

关 键 词：胆道肿瘤 胆囊癌 根治性切除 淋巴结转移 预后因素 辅助治疗 

分 类 号：R735.8[医药卫生—肿瘤]