438例胆囊癌外科治疗及预后因素分析  

Prognostic factors and surgical treatment of gallbladder carcinoma in 438 patients

作　　者：耿智敏[1] 王林[1] 陈晨[1] 慎浩鑫 宋虎伟 石磊[1] 王作仁[1] 赵亚玲[2] 刘青光[1] 

机构地区：[1]西安交通大学第一附属医院肝胆外科,710061 [2]西安交通大学医学院公共卫生系卫生统计教研室,710061

出　　处：《中华消化外科杂志》2016年第4期346-352,共7页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金（81572420）

摘　　要：目的分析胆囊癌的临床特点，总结外科治疗经验，探讨影响患者预后的相关因素。方法采用回顾性横断面调查研究方法。收集2008年1月至2012年12月西安交通大学第一附属医院收治的438例胆囊癌患者的临床资料。患者行影像学检查和实验室检查，根据检查结果进行术前分朗并制订手术方案。分析患者临床表现特征、影像学和实验室检查结果、手术结果、病理学检查结果、随访及生存情况。将人口学特征（性别、年龄、血型），基础疾病（高血压病、糖尿病），临床病理特征（术前黄疸、胆囊结石、腹腔积液、手术方式、意外胆囊癌、术中出血量、肿瘤位置、肿瘤形态、病理学类型、病理学分级、TNM分期、肝脏浸润、原发病灶、淋巴结转移及远处转移）进行单因素和多因素分析。采用门诊或电话随访，以患者死亡为终点，了解患者生存情况，随访时间截至2014年10月。计数资料采用百分比表示，Kaplan-Meier法绘制生存曲线，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）临床表现特征：438例患者中，右季肋区疼痛328例，纳差178例，体质量减轻135例，黄疸114例，恶心、呕吐65例，腹胀39例，乏力37例，腹上区包块25例，发热21例，无症状40例。438例患者中259例合并胆囊结石，7例合并胆总管结石，81例合并高血压病，34例合并糖尿病，13例合并病毒性肝炎。（2）影像学和实验室检查结果：超声检查诊断率为78．47％（277／353），CT检查诊断率为78．50％（252／321），MRI诊断率为59．68％（74／124）。CA19-9升高占58．17％（146／251），CA125升高占48．90％（111／227），CEA升高占35．04％（96／274）。（3）手术结果：438例患者行手术治疗，其中Rn切除165例，R1切除19例，R2切除254例。93例患者术中明确伴随腹腔积液症状。67例患者为意外�Objective To analyze the clinical characteristics of gallbladder carcinoma （GBC）, summarize surgical experiences and investigate prognostic factors. Methods The retrospective cross-sectional study was adopted. The clinical data of 438 patients with GBC who underwent surgery at First Affiliated Hospital of Xi＇an Jiaotong University from January 2008 to December 2012 were collected. The surgical plan was determined according to the preoperative stage by imaging and laboratory examinations. The clinical characteristics, results of imaging examination and laboratory examination, surgical result, results of pathological examination, follow-up and survival situations were analyzed. There were univariate and multivariate analyses on the demographic characteristics （gender, age and blood type） , underlying diseases （hypertension and diabetes mellitus）, clinical pathological characteristics （preoperative jaundice, gallstone history, peritoneal effusion, surgical method, unsuspected gallbladder carcinoma, volume of intraoperative blood loss, tumor location, tumor morphology, pathological type, tumor differentiation, TNM stage, liver infiltration, primary lesion, lymph node metastasis and distant metastasis）. The follow-up by outpatient examination and telephone interview was performed to detect the survival of patients up to October 2014 with death as end point. Count data were reprensted as percentage. The survival curve was drawn by the Kaplan-Meier method. The univariate analysis and multivariate analysis of prognosis were respectively done using the Log-rank test and COX regression model. Results （i） Clinical characteristics： of 438 patients, pain in the right hypochondriac region was detected in 328 patients, anorexia in 178 patients, body weight loss in 135 patients, jaundice in 114 patients, nausea and vomiting in 65 patients, abdominal distension in 39 patients, malaise in 37 patients, mass in the epigastric region in 25 patients, fever in 21 patients and no symptom in 40 patients. Among all

关 键 词：胆囊肿瘤 根治性切除 淋巴转移 预后因素 

分 类 号：R735.8[医药卫生—肿瘤]