胆囊癌外科治疗与临床预后分析  

Surgical treatment and clinical prognosis of gallbladder cancer

作　　者：宋晓玲[1] 梁海滨[1] 王卫民 黄灵[1] 刘颖斌[1] 顾钧[1] 

机构地区：[1]上海交通大学医学院附属新华医院普外科,上海200092 [2]上海市崇明县第三人民医院普外科,上海202153

出　　处：《肝胆胰外科杂志》2016年第6期465-468,共4页Journal of Hepatopancreatobiliary Surgery

基　　金：国家自然科学基金项目(81572819)

摘　　要：目的研究胆囊癌临床特征,分析探讨影响其预后的有关因素,为提高胆囊癌预后提供临床依据。方法选取我院2008年1月至2014年12月96例胆囊癌患者的临床资料,采用Kplan-Meier法对确定的单因素进行生存分析,用Cox回归法进行多因素分析。结果单因素生存分析显示,手术方式(x^2=32.209,P<0.001)、TNM分期(x^2=109.408,P<0.001)、淋巴结转移(x^2=69.691,P<0.001)、肿瘤部位(x^2=10.667,P=0.014)、p53(P<0.05)、MSH2(P<0.05)和CK7(P<0.05)影响胆囊癌预后,而年龄(x^2=10.039,P=0.844)、性别(x^2=0.664,P=0.415)等与胆囊癌预后无关。Cox多因素分析发现:TNM分期(P<0.001)、手术方式(P=0.004)、淋巴结转移(P=0.008)为影响胆囊癌预后的独立危险因素。结论胆囊癌呈现发病隐匿、临床症状无特异性、恶性程度高且预后差等特点。其中多数患者伴有腹痛、胆囊结石、黄疸、淋巴结转移,TNM分期越高的患者预后更差,根治性切除术可改善患者的预后。多因素分析表明TNM分期、手术方式、淋巴结转移为影响胆囊癌预后的独立危险因素。Objective To investigate the relationship between various clinicopathologic factors and progno-sis of patients with gallbladder cancer. Methods A retrospective clinical analysis was conducted in 96 cases of gallbladder cancer treated in our hospital between Jan. 2008 and Dec. 2014. Results The results of univariateanalysis showed that radical resection （x^2=32.209, P〈0.001）, TNM stage （x^2=l09.408, P〈0.001）, lymph node metastasis （x^2=69.691, P〈0.001）, tumor location （x^2=10.667, P=0.014）, p53 （P〈0.05）, MSH2 （P〈0.05） and CK7 （P〈0.05） significantly correlated with the prognosis of the patients with gallbladder cancer. The results of Cox regression indicated that the radical resection （P=0.004）, lymph node metastasis （P=0.008） and TNM stage （P〈0.001） were independent prognostic factors of gallbladder cancer. Conclusion The main characteristics of gallbladder cancer are high aggressivity and extremely poor prognosis. Radical resection, early TNM stage and no lymph node metastasis will be helpful to improve the prognosis of gallbladder cancer.

关 键 词：胆囊癌 外科治疗 临床预后 

分 类 号：R735.8[医药卫生—肿瘤]