T2期胆囊癌行肝楔形切除与肝Ⅳb+Ⅴ段切除根治术的疗效分析  

Efficacy analysis of liver wedge resection and liverⅣb andⅤsegmentectomy for T2 gallbladder carcinoma

作　　者：李起 唐祯齐 刘恒超 马煜博 陈晨[1] 张东[1] 耿智敏[1] Li Qi;Tang Zhenqi;Liu Hengchao;Ma Yubo;Chen Chen;Zhang Dong;Geng Zhimin(Department of Hepatobiliary Surgery,The First Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710061,China)

机构地区：[1]西安交通大学第一附属医院肝胆外科,西安710061

出　　处：《中华消化外科杂志》2024年第7期934-943,共10页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金(62076194);陕西省重点研发计划(2021SF⁃016、2022⁃SF⁃606)。

摘　　要：目的探讨T2期胆囊癌行肝楔形切除与肝Ⅳb+Ⅴ段切除根治术的疗效。方法采用回顾性队列研究方法。收集2011年1月至2021年12月西安交通大学第一附属医院收治的168例行T2期胆囊癌根治术患者的临床病理资料;男59例,女109例;年龄为(65±10)岁。168例患者中,112例为T2a期,56例为T2b期。112例T2a期胆囊癌患者中,73例行肝楔形切除术,39例行肝Ⅳb+Ⅴ段切除术。56例T2b胆囊癌患者中,27例行肝楔形切除术,29例行肝Ⅳb+Ⅴ段切除术。正态分布的计量资料以x±s表示,偏态分布的计量资料以M(范围)表示。计数资料以绝对数表示,组间比较采用χ^(2)检验或Fisher确切概率法。等级资料比较采用Mann⁃Whitney U检验。采用Kaplan⁃Meier法计算生存率和绘制生存曲线,Log⁃rank检验进行生存分析。单因素和多因素分析采用COX比例风险模型。结果(1)行不同肝切除范围T2期胆囊癌患者临床资料分析。行不同肝切除范围T2a期和T2b期胆囊癌患者的性别、年龄、胆囊结石、术前总胆红素、癌胚抗原、CA19⁃9、CA125、意外胆囊癌、神经浸润、脉管瘤栓、病理学分化程度、组织病理学类型、N分期及TNM分期比较,差异均无统计学意义(P>0.05)。(2)行不同肝切除范围T2期胆囊癌患者预后分析。T2期胆囊癌患者行肝楔形切除术1、3、5年累积无复发生存率分别为78.0%、60.1%、51.4%,行肝Ⅳb+Ⅴ段切除术患者上述指标分别为86.8%、80.0%、68.0%,两者比较,差异有统计学意义(χ^(2)=5.205,P<0.05)。T2期胆囊癌患者行肝楔形切除术1、3、5年累积总生存率分别为85.0%、62.5%、55.1%,行肝Ⅳb+Ⅴ段切除术患者上述指标分别为92.6%、81.6%、68.8%,两者比较,差异有统计学意义(χ^(2)=4.351,P<0.05)。T2b期胆囊癌患者行肝楔形切除术1、3、5年累积无复发生存率分别为70.4%、45.9%、39.2%,行肝Ⅳb+Ⅴ段切除术患者上述指标分别为89.7%、71.3%、54.0%,两者比较,差异有�Objective To investigate the efficacy of liver wedge resection and liverⅣb andⅤsegmentectomy for T2 gallbladder carcinoma(GBC).Methods The retrospective cohort study was conducted.The clinicopathological data of 168 patients who underwent radical resection of T2 GBC in The First Affiliated Hospital of Xi′an Jiaotong University from January 2011 to December 2021 were collected.There were 59 males and 109 females,aged(65±10)years.Of 168 patients,there were 112 cases in T2a stage and 56 cases in T2b stage.Of 112 patients in T2a stage,73 cases underwent liver wedge resection and 39 cases underwent liverⅣb andⅤsegmentectomy.Of 56 patients in T2b stage,27 cases underwent liver wedge resection and 29 cases underwent liverⅣb andⅤsegmentectomy.Measurement data with normal distribution were represented as Mean±SD,and measurement data with skewed distribution were represented as M(range).Count data were described as absolute numbers,and comparison between groups was conducted using the chi‐square test or Fisher exact probability.Comparison of ordinal data was conducted using the Mann‐Whitney U test.The Kaplan‐Meier method was used to calculate survival rate and draw survival curve,and the Logrank test was used for survival analysis.The COX proportional risk model was used for univariate and multivariate analyses.Results(1)Clinical data analysis of patients undergoing different extent of hepatic resection for T2 GBC.There was no significant difference in gender,age,cholecystolithiasis,preoperative total bilirubin,carcinoembryonic antigen,CA19-9,CA125,incidental GBC,perineural invasion,microvascular invasion,pathological differentiation,histopathological subtypes,N staging,TNM staging between patients with T2a and T2b GBC who underwent different extent of hepatic resection(P>0.05).(2)Prognostic analysis of T2 GBC patients undergoing different extent of hepatic resection.The 1‐,3‐and 5‐year cumulative disease‐free survival rates of T2 GBC patients undergoing liver wedge resection were 78.0%,60.1%a

关 键 词：胆道肿瘤 胆囊 肝楔形切除 肝Ⅳb+Ⅴ段切除 预后 并发症 

分 类 号：R735.8[医药卫生—肿瘤]