意外胆囊癌新辅助化疗10例疗效分析  

Efficacy analysis of neoadjuvant chemotherapy for 10 cases of incidental gallbladder cancer

作　　者：李起 张小弟 张东[1] 陈晨[1] 刘恒超 李孟柯 锁爱莉[2] 吴胤瑛[2] 耿智敏[1] LI Qi;ZHANG Xiao-di;ZHANG Dong(Department of Hepatobiliary Surgery,the First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China;不详)

机构地区：[1]西安交通大学第一附属医院肝胆外科,陕西西安710061 [2]西安交通大学第一附属医院肿瘤内科,陕西西安710061 [3]陕西核工业二一五医院普通外科,陕西咸阳712000

出　　处：《中国实用外科杂志》2023年第8期906-910,共5页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金项目(No.62076194);陕西省重点研发计划项目(No.2021SF-016;No.2022-SF-606)。

摘　　要：目的 探讨新辅助化疗对于意外胆囊癌的疗效。方法 回顾性分析2014年6月至2022年8月于西安交通大学第一附属医院(7例)及陕西核工业二一五医院(3例)因意外胆囊癌接受新辅助化疗后行手术治疗的10例病人的临床资料。分析意外胆囊癌接受新辅助化疗的不良反应发生率及行手术治疗后的效果。结果 10例病人中,术前接受GS方案者5例、GP方案者3例、SOX方案2例,新辅助化疗中位周期为2(2~4)个周期。化疗不良事件发生率为40.0%(4/10例)。再次手术时间为9(3~16)周。1例病人仅行腹腔镜探查活检术,1例行姑息性胆管切除术+胆肠吻合术,其余8例行胆囊癌意向性根治性切除术的病人均为R0切除,根治性切除率为80.0%(8/10)。术中清扫淋巴结总数为47枚,清扫淋巴结数目中位数为4(4~10)枚。手术时间为(240.4±56.1)min,出血量为300(10~600)m L,术中输血量红细胞为2(0~4)U、血浆0(0~400)m L。TNMⅡA期1例,ⅢA期6例,ⅢB期1例,ⅣB期2例。1例病人术后发生胆漏。结论 新辅助化疗对于意外胆囊癌病人疗效良好,不良反应小、安全性较高,可能具有一定的临床价值,值得进一步深入研究。Objective To explore the efficacy of neoadjuvant chemotherapy for incidental gallbladder cancer.Methods The clinicopathological data of 10 patients who underwent surgical resection for incidental gallbladder cancer after neoadjuvant chemotherapy from June 2014 to August 2022 in the First Affiliated Hospital of Xi'an Jiaotong University(7 cases)and No.215 Hospital of Shaanxi Nuclear Industry(3 cases)were retrospectively analyzed.The incidence of adverse effects and the clinical outcome for incidental gallbladder cancer after surgical resection treated with neoadjuvant chemotherapy were analyzed.Results Among the 10 patients,there were 9 patients received GS regimen,5 patients received GP regimen,and 2 patients received SOX regimen before surgery.The median cycle of neoadjuvant chemotherapy was 2(range:2-4)cycles.The incidence of adverse events of neoadjuvant chemotherapy was 40.0%(4/10).Re-operation time was 9(3-16)weeks.1 patient underwent laparoscopic exploratory and biopsy only,1 patient underwent palliative hepaticojejunostomy,and 8 patients who underwent curative-intent resection for gallbladder cancer were all achieved R0 resections,with a radical resection rate of 80%(8/10 patients).The total number of intraoperative lymph nodes dissection was 47,and the median number of lymph nodes dissection was 4(range:4-10).The operation time was(240.4±56.1)minutes,the blood loss was 300(range:200-600)mL,the red blood cell transfusion volume was 2(range:0-4)U,and the plasma transfusion volume was 0(range:0-400)mL.There was 1 patient with TNM stage IIA,6 patients with stage IIIA,1 patient with stage IIIB,and 2 patients with stage IVB.Postoperative bile leakage occurred in 1 patient.Conclusion Neoadjuvant chemotherapy has good clinical outcomes,less adverse reactions,and high safety for patients with incidental gallbladder cancer,which may have a certain clinical value and be worth further studying.

关 键 词：意外胆囊癌 新辅助化疗 R0切除 并发症 

分 类 号：R6[医药卫生—外科学]