局部进展期胆囊癌转化手术的安全性及有效性分析:一项单中心回顾性研究  

Analysis of safety and effectiveness of conversion surgery for locally advanced gallbladder cancer:a singlecenter retrospective study

作　　者：张宇[1,7] 宋晓玲 杨春弘[8] 朱逸荻 李怀峰 杨自逸 吴自友[7] 陈素芸 周晴 任刚 沈伟[5] 李茂岚 全志伟[1,7] 刘颖斌[8] 管雯斌 吴向嵩[1,7] 龚伟[1,7] ZHANG Yu;SONG Xiao-ling;YANG Chun-hong(Department of General Surgery,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine Shanghai Key Laboratory of Biliary Tract Disease Research,Shanghai Research Center of Tract Disease,Research Institute of Biliary Tract Disease,Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China;不详)

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]上海交通大学医学院附属新华医院核医学科,上海200092 [3]上海交通大学医学院附属新华医院肿瘤科,上海200092 [4]上海交通大学医学院附属新华医院医学影像科,上海200092 [5]上海交通大学医学院附属新华医院肛肠外科,上海200092 [6]上海交通大学医学院附属新华医院病理科,上海200092 [7]上海市胆道疾病研究中心上海市胆道疾病研究重点实验室、上海交通大学医学院胆道疾病研究所,上海200092 [8]上海交通大学医学院附属新华医院科研中心,上海200092 [9]上海交通大学医学院附属仁济医院胆胰外科,上海200127

出　　处：《中国实用外科杂志》2024年第9期1068-1074,共7页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金(No.82172628,No.82173048,No.82373370);上海市卫健委卫生健康学科带头人项目(No.2022XD010);上海市科学技术委员会“科技创新行动计划”医学创新研究专项项目(No.22Y11908000)。

摘　　要：目的评估局部进展期胆囊癌转化手术的围手术期安全性及有效性。方法回顾性分析上海交通大学医学院附属新华医院2020年1月至2023年12月的11例接受转化治疗的局部进展期胆囊癌病人的临床资料,分析转化手术的围手术期安全性和有效性。结果11例病人均为上海交通大学医学院附属新华医院胆道肿瘤多学科综合治疗协作组团队评估为局部进展期胆囊癌病人。术前转化治疗中位周期为3(2~4)个周期,Ⅲ级以上转化治疗毒副反应发生率为27.3%。手术时间为363.0(300.0~415.0)min,术中出血量为400(200~500)mL,术中需要输血7例。11例病人中,无二次手术病人、无围手术期死亡病人、无Clavien-Dindo 3级以上并发症,6例病人术后出现Ⅱ级并发症:5例病人发生贫血,1例病人发生肺部感染,2例病人发生胸腔积液,2例病人发生胃排空障碍。术后住院时间为15(11~33)d。11例病人均为R0切除,手术清扫淋巴结中位数目为14(9~19)枚。8例病人实现降期,术后中位随访时间为9(6~19)个月,截至末次随访,4例病人出现复发,中位无进展生存期为8.0个月(95%CI 4.06~21.94)。结论转化手术对于局部进展期胆囊癌病人具有良好的围手术期安全性,给病人提供了R0切除的手术机会,早期预后良好,值得进一步深入研究探索。To evaluate the perioperative safety and efficacy of conversion surgery for locally advanced gallbladder cancer.Methods Clinical records of 11 patients with locally advanced gallbladder cancer who received conversion surgery from January 2020 to December 2023 at Xinhua Hospital,Shanghai Jiaotong University School of Medicine were retrospectively collected.The perioperative safety and efficacy of conversion surgery for these patients were analysed.Results All 11 patients were categorized as locally advanced gallbladder cancer after evaluation by our Biliary Tumor Multidisciplinary team.The median number of cycles of preoperative conversion therapy was 3(interquartile range:2-4),and the incidence of gradeⅢor higher treatment-related adverse events was 27.3%.The operation time was 363.0(interquartile range:300.0-415.0)min,intraoperative blood loss was 400(interquartile range:200-500)mL,and 7 patients received intraoperative blood transfusion.Postoperatively,there was no incidence of re-operation,mortality,or gradeⅢor higher Clavien-Dindo complications.Six patients developed gradeⅡClavien-Dindo complications including 5 cases of postoperative anemia,one case of postoperative pneumonia,2 cases of pleural effusion,and two cases of delayed gastric emptying.Postoperative hospital stay was 15(interquartile range:11-33)days.All 11 patients achieved R0 resection,and the median number of harvested lymph nodes was 14(interquartile range:9-19).Eight patients achieved a downstaging effect after conversion therapy.The median time of postoperative follow-up was 9(interquartile range:6-19)months,and at the last follow-up,tumor recurrence occurred in 4 patients,with a median progression-free survival of 8(95%Confidence Interval,4.06-21.94)months.Conclusion Conversion surgery can be performed safely for patients with locally advanced gallbladder cancer,providing them with an opportunity to achieve R0 resection and showing a good early prognosis.Further studies are worthy of being conducted in the future.

关 键 词：胆囊癌 局部进展期 转化治疗 转化手术 

分 类 号：R6[医药卫生—外科学]