不同部位早期胆囊癌手术的预后分析

Prognostic analysis of surgical treatment for early gallbladder carcinoma in different location

目的 探讨胆囊切除后早期胆囊癌生物学特性和手术疗效。方法 总结分析因胆囊切除而发现的28例早期胆囊癌的临床病理特征,对不同期别和部位胆囊癌的胆囊切除疗效予以长期随访评估。结果 pT2期胆囊癌无5年生存;pT1期病例5年生存率为77.78％,10年生存率为35.7％。7例pT1期胆囊颈部癌中的4例于2年内死于肿瘤复发,13例pT1期胆囊底部、体部癌5年生存率达84.6％,10年生存率为45.45％,与胆囊颈部癌比较有显著差异(P<0.05)。pTis均生存5年以上。结论 胆囊切除治疗pT1期胆囊颈部癌和pT2期胆囊癌预后差,可能与其易发生淋巴结转移、血管浸润、胆道腔内种植性转移等生物学特性有关。pTis、pT1期胆囊底部、体部癌可仅予单纯胆囊切除治疗。

Objective To investigate the clinical and pathological profiles of early gallbladder carcinoma diagno-sised after cholecystectomy and the efficacy of operation. Methods Twenty-eight cases with early stage of gallbladder carcinoma from two hospitals were analysised and assessed if cholecystectomy as a surgical strategy was suitable or not with the long term follow-up results according to the location and the invasive depth of the rumor. Results There was no 5-years survival in pT2. In pT1 patients, the 5-years and 10-years survival rates were 77. 78% and 35. 7% respectively. But 4 of 7 patients with the neck tumor of pT1 stage died of tumor reculence within 2 years after operation. The 5 years and 10 years survival rates of the pT1 patients with the tumor not located in the neck of gallbladder were 84.6% and 45.45% respectively (P < 0. 05, vs neck tumor of gallbladder). Three patients with pTis have survived longer than 5 years till now. Conclusion Cholecystectomy seems to be sui-table to stages pTis and pT1 tumors not located in the neck of gallbladder, but not suitable to stages pT2 and pT1 tumors located in the neck of gallbladder, which might be related to the higher possibility of biological profiles such as lymph metastasis, vein infiltration and/or intraluminal implantation.