意外胆囊癌的临床诊治分析  

Diagnosis and treatment of incidental gallbladder cancer

作　　者：郑刚[1,2] 丁佑铭[1] 

机构地区：[1]武汉大学人民医院普外科,武汉430072 [2]荆门市第一人民医院普外科,湖北荆门448000

出　　处：《临床与病理杂志》2015年第3期428-432,共5页Journal of Clinical and Pathological Research

摘　　要：目的:探讨意外胆囊癌(incidental gallbladder cancer,IGBC)的临床特点、治疗方法和预后。方法:回顾性分析2004年1月~2014年6月收治的47例IGBC的临床病理资料,对其治疗方法及预后影响因素进行分析。结果:T1a期14例,T1b期15例,T2期14例,T3期4例。1、3、5年累计总生存率分别为94.7%、75.8%、57.2%,术后切口种植率为4.2%(2/47)。多因素分析显示,T期、手术方式、组织学分级是影响IGBC预后的独立因素(P<0.05)。对于T1b期患者,单纯胆囊切除术与胆囊癌根治术后生存率差异无统计学意义(P=0.278);对于T2期患者,单纯胆囊切除术与胆囊癌根治术后生存率差异有统计学意义(P=0.042)。结论:IGBC分期较早,对于高危患者做快速冰冻切片有助于发现IGBC。对于T1a期行单纯胆囊切除术即可,T1b^T3期患者确诊后应尽早行根治术。Objective： To explore the clinical characteristics treatment and prognosis of incidental gallbladder cancer （IGBC）. Methods： The clinical and pathological data of 47 patients with IGBC from Jan 2004 to Jun 2014 were retrospectively summarized, in which different treatment and factors affecting prognosis were analyzed. Results： There were 14 patients with stage Tla, 15 patients with stage Tlb, 13 patients with stage T2, 4 patients with T3. The 1-, 3-, and 5-year overall survival rate were respectively 94.7%, 75.8%, and 57.2%. Two cases with incision metastasis were found postoperatively. Multivariate analysis showed that T stage, surgical type and histological differentiation were the independent factors for prognosis of IGBC （P〈0.05）, The difference in survival rate between patients who received pure cholecystectomy and those who received radical surgery was not significant in stage Tlb （P=0.278）, but there was significant difference of survival between the two surgical type in stage T2 （P=0.042）. Conclusion： Patients with IGBC showed early stage. Frozen section examination should be performed for the patients with high risk factors. Simple cholecystectomy is appropriate for Tla patients, whereas radical resection is recommended for patients with stage Tlb or more advanced IGBC.

关 键 词：意外胆囊癌 诊断 治疗 预后 

分 类 号：R735.8[医药卫生—肿瘤]