意外胆囊癌诊断与治疗的多中心回顾性研究（附223例报告）  

Diagnosis and treatment of unexpected gallbladder carcinoma： a multicenter retrospective study （ A report of 223 cases）

作　　者：巩鹏[1] 刘鹏[1] 张贤彬[1] 耿智敏[2] 翟文龙[3] 邱应和[4] 宋天强[5] 何宇 李敬东[7] 李升平[8] 汤朝晖[9] 

机构地区：[1]大连医科大学附属第一医院肝胆外科,116011 [2]西安交通大学第一附属医院肝胆外科,710061 [3]郑州大学第一附属医院肝胆胰外科,450052 [4]第二军医大学附属东方肝胆外科医院胆道二科,上海200438 [5]天津医科大学附属肿瘤医院肝胆肿瘤科,300060 [6]陆军军医大学(第三军医大学)第一附属医院全军肝胆外科研究所中国人民解放军西南肝胆外科医院,重庆400038 [7]川北医学院附属医院肝胆外科,四川南充637000 [8]中山大学肿瘤防治中心肝胆科,广州510060 [9]上海交通大学医学院附属新华医院普通外科,200092

出　　处：《中华消化外科杂志》2018年第3期252-256,共5页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金（81572420、81270533、81473504）;上海市科学技术委员会科技创新行动计划（15441903702）;辽宁省百千万人才工程（[2015]66号）;河南省科技创新人才支持计划（14HASTIT030）

摘　　要：目的：分析国内多中心意外胆囊癌病理结果及治疗现状，探讨意外胆囊癌的诊断与治疗要点。方法：采用回顾性横断面研究方法。收集2010年1月至2016年12月国内8家医疗中心收治的223例［西安交通大学第一附属医院86例、郑州大学第一附属医院41例、第二军医大学附属东方肝胆外科医院30例、上海交通大学医学院附属新华医院27例、大连医科大学附属第一医院13例、天津医科大学附属肿瘤医院11例、陆军军医大学（第三军医大学）第一附属医院9例、川北医学院附属医院6例］意外胆囊癌患者的临床病理资料。经术中快速冷冻切片病理学检查确诊的和经术后病理学检查确诊的意外胆囊癌处理方法依据《胆囊癌诊断和治疗指南（2015版）》。术后行或不行辅助治疗综合肿瘤分期及患者意愿。观察指标：（1）意外胆囊癌诊断与治疗情况。（2）随访和生存情况。采用门诊和电话方式进行随访，了解患者术后生存情况。随访时间截至2017年6月。正态分布的计量资料以±s表示；偏态分布的计量资料以M（范围）表示。采用Kaplan-Meier法计算患者生存时间。结果：（1）意外胆囊癌诊断与治疗情况：223例意外胆囊癌患者中，80例为首次术中快速冷冻切片病理学检查诊断［其中20例报告了肿瘤T分期（14例术中肿瘤T分期与术后不符）、60例未报告肿瘤T分期］，143例为首次术后病理学检查诊断（其中13例为首次术中快速冷冻切片病理学检查诊断胆囊良性疾病，130例首次术中未行快速冷冻切片病理学检查）。223例意外胆囊癌患者中，腺癌209例，腺瘤恶变10例，神经内分泌肿瘤3例，鳞癌1例；Tis期6例，T1a期16例，T1b期32例，T2期73例，T3期75例，T4期12例，未明确分期9例；行二次手术患者140例，其中胆囊癌根治术106例、胆囊癌扩大根治术34例；手术达标126例、不达标97例�Objective：To analyze the pathological results and current treatment situation of patients with unexpected gallbladder carcinoma from multi-centers in China, and explore the diagnosis and treatment of unexpected gallbladder carcinoma. Methods：The retrospective cross-sectional study was conducted. The clinicopathological data of 223 patients with unexpected gallbladder carcinoma who were admitted to the 8 clinical centers from January 2010 to December 2016 were collected, including 86 in the First Affiliated Hospital of Xi′an Jiaotong University, 41 in the First Affiliated Hospital of Zhengzhou University, 30 in the Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University, 27 in the Xinhua Hospital of Shanghai Jiaotong University, 13 in the First Affiliated Hospital of Dalian Medical University, 11 in the Tianjin Medical University Cancer Institute ＆ Hospital, 9 in the First Affiliated Hospital of Army Medical University （Third Military Medical University） and 6 in the Affiliated Hospital of North Sichuan Medical College. Treatment of patients with unexpected gallbladder carcinoma who were diagnosed by intraoperative frozen section biopsy and postoperative pathological examination followed guideline for the diagnosis and treatment of gallbladder carcinoma （2015 edition）. According to tumor staging and patients′ decision, postoperative adjuvant treatment was selectively performed. Observation indicators： （1） diagnosis and treatment of unexpected gallbladder carcinoma; （2） follow-up and survival. Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival up to June 2017. Measurement data with normal distribution were represented as ±s. Measurement data with skewed distribution were described as M （range）. The survival time was calculated using the Kaplan-Meier method. Results：（1） Diagnosis and treatment of unexpected gallbladder carcinoma： of 223 patients with unexpected gallbladder carcinoma, 80 were i

关 键 词：意外胆囊癌 胆道肿瘤 外科手术 病理学检查 预后 多中心 回顾性研究 

分 类 号：R735.8[医药卫生—肿瘤]