影响意外胆囊癌治疗决策及疗效的因素

Evaluation of factors influencing management strategy and effect of unsuspected gallbladder carcinoma

目的探讨影响意外胆囊癌治疗决策及疗效的因素,以提高意外胆囊癌患者的疗效与预后。方法采用F isher精确概率计算法,分析15例意外胆囊癌患者死亡与发现时TNM分期或Nevin分期及胆囊破裂的相关性,探讨意外胆囊癌患者发现时间、发现时TNM分期或Nevin分期、胆囊破裂、第一次手术及是否再手术、胆囊结石病程长短和年龄与患者生存时间的关系。结果11例意外胆囊癌术后诊断,1例尸检诊断,3例术中诊断。术后诊断的时间1周到2年不等,4例有胆囊破裂,术后7个月死于胆囊癌,11例无胆囊破裂术后存活。本组意外胆囊癌患者死亡与TNM分期或Nevin分期的相关性统计学分析,P=0.0007,与胆囊破裂的相关性的统计学分析,P=0.0003。术后较早诊断的意外胆囊癌以早期胆囊癌多,术后较晚诊断的多是晚期胆囊癌。晚期意外胆囊癌多见于胆囊结石病程较长的老年患者。结论意外胆囊癌的发现时间、TNM或Nevin分期、第一次手术方式和再手术、有无胆囊破裂、胆囊结石的病程、患者年龄是影响意外胆囊癌治疗决策和疗效的因素。

Objective To improve the survival of the patients with unsuspected gallbladder carcinoma and to investigate the factors influencing management strategy and effect of unsuspected gallbladder were evaluated. Methods 15 cases with unsuspected gallbladder carcinoma were retrospectively analyzed. The average duration of choleeysto- lithiasis was 12.9 years. Preoperative diagnosis of 15 cases consisted of 12 patients with Cholecystolithiasis and 3 pa- tients with gallbladder polypoid. 3 cases with unsuspected gallbladder carcinoma were diagnosed intraoperatively. The relationships between survival time and patient＇ s age, duration of cholecystolithiasis, diagnosis time, TNM or Nevin stage of unsuspected gallbladder carcinoma and operative choice, intraoperative gallbladder rupture and re-operation were evaluated. Results 1 l cases were diagnosed after operation, 1 case was diagnosed by autopsy and 3 cases were diagnosed intraoperatively. The time of the postoperative established diagnosis for unsuspected gallbladder carcinoma was between 1 week and 2 years,and 5 cases were re-operated. Intraoperative gallbladder rupture and bile spillage oc- curred in 4 cases, and the 4 cases died within 7 months after operation. 11 cases without gallbladder rupture survived. Conclusions The time of diagnosis,TNM and Nevin stage of unsuspected gallbladder carcinoma, operation choice, introperative gallbladder rupture, the duration of cholecystolithiasis and the age are factors influencing the management strategy and effect of unsuspected gallbladder carcinoma.