晚期胆囊癌的外科治疗及预后分析  

Prognostic factors and surgical treatment of advanced gallbladder carcinoma

作　　者：温志坚[1,2] 杨珏[1] 杨平华[1] 杨新伟[1] 闫兴洲[1] 刘虎[1] 曾建军[2] 王志斌[2] 张宝华[1] 

机构地区：[1]第二军医大学东方肝胆外科医院腹腔镜科,上海200438 [2]解放军第一七四医院肝胆胰血管外科,厦门361003

出　　处：《肝胆外科杂志》2016年第5期337-343,共7页Journal of Hepatobiliary Surgery

基　　金：国家自然科学基金(81372674)

摘　　要：目的分析晚期胆囊癌(UICC III、IV期)的临床特点,总结外科治疗经验,探讨提高晚期胆囊癌生存率的方法。方法回顾性分析东方肝胆外科医院2002年01月至2012年12月收治的360例晚期胆囊癌的患者资料。Kaplan-Meier法绘制生存曲线,单因素分析采用Log-rank检验,多因素采用COX回归模型。结果 360例中312例得到有效随访,中位随访时间为42.0个月,中位生存时间为17.6个月。1、3、5年生存率分别为68.0%、30.7%及15.4%。单因素分析结果:术前黄疸、手术方式、意外胆囊癌、肿瘤位置、肝外胆管切除、手术切缘、肝侵犯、病理学分级、T分期、N分期、M分期均是影响患者预后的危险因素。多因素分析结果:N分期、病理学分级、肝侵犯、手术切缘、手术方式均是影响患者预后的独立危险因素。结论晚期胆囊癌预后差,积极的外科手术可改善患者预后。N分期、病理学分级、肝侵犯、手术切缘、手术方式均是晚期胆囊癌外科治疗预后不良的独立危险因素。Object To analyze the clinical charactersitics of advanced gallbladder carcinoma（ AGBC）, summarize surgical ex- periences and investigate method to improve the survival rate. Methods The clinical data of 360 patients with AGBC （UICC III,IV stage） who underwent surgery from Jan. 2002 to Dec. 2012 at Eastern Hepatobihary Surgery Hospital were retrospectivaly reviewed. 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 Of 360 patients, 312 were followed up for a median time of 42.0 months, and median survival time was 17. 6 months. The 1-,3-,5-year survival rates were 68. 0% , 30. 7% and 15.4% respectively. The results of univariate analysis showed that preoperative jaundice, operation method, unexpected gallbladder carcinoma, tumor loca- tion, and extrahepatic bile duct resection, surgical margin, liver invasion, pathological classification, T stage, N stage and M stage were risk factors affecting the prognosis of patients. The results of multivariate analysis showed that N stage, pathological classification, hepatic invasion, surgical margin, operation method are independent risk factors affecting the prognosis of patients. Conclusion The prognosis of advanced gallbladder carcinoma was poor. Aggressive surgical resection could improve the prognosis of patients, and N stage, pathological classification, hepatic invasion, surgical margin, operation method were independent risk factors affecting the prog- nosis of AGBC patients.

关 键 词：晚期胆囊癌 外科治疗 预后因素 

分 类 号：R735.8[医药卫生—肿瘤]