胆囊癌术式的选择与预后

Selection of surgical procedures for cholangiocarcinoma and the corresponding prognosis

目的 探讨不同分期胆囊癌术式的选择与预后的关系。方法回顾性分析2001年1月至2007年5月107例胆囊癌患者的临床资料，分析不同分期选择的术式及生存情况。结果107例随访81例，随访率75．6％，平均随访时间5年。Ⅰ期胆囊癌10例，均行单纯胆囊切除术，9例生存，1例死亡。Ⅱ期胆囊癌8例，行姑息性胆囊切除术3例，中位生存期12个月；行根治术5例，中位生存期24个月，两者中位生存期比较差异有统计学意义（X^2=5．698，P〈0．05）。Ⅲ期胆囊癌42例，行根治术18例，中位生存期24个月；扩大根治术5例，中位生存期18个月，两者中位生存期比较差异无统计学意义（X^2=0．238，P〉0．05）；行姑息性手术19例，巾位生存期6个月，与行根治术及扩大根治术中位生存期比较差异有统计学意义（）（。=5．772，6．318，P〈0．05）。Ⅳ期胆囊癌47例，行扩大根治术17例，姑息性手术30例，各术式中位生存期比较差异无统计学意义（X^2=0．001，0．694，P〉0．05）；行扩大根治术的并发症发生率显著高于姑息性手术（X^2=6．039，P〈0．05）。结论Ⅰ期胆囊癌行单纯胆囊切除术，Ⅱ期胆囊癌行根治术，Ⅲ期胆囊癌根据侵犯范围选择根治术或扩大根治术，Ⅳ期胆囊癌选择姑息性手术。

Objective To discuss the relationship between prognosis and different surgical procedures for gallbladder cancer in different stages. Methods The clinical data of 107 patients with gallbladder cancer from January 2001 to May 2007 were retrospectively analyzed. The surgical procedure was chosen according to different stages. Results Eighty-one of the 107 patients （75.6%） were followed up with the median time of 5 years. Of the 10 patients with stage Ⅰ gallbladder cancer who had underwent simple eholecystectomy, 9 survived. Of the 8 patients with stage Ⅱ gallbladder cancer, 3 received palliative cholecystectomy and the median survival time was 12 months, which was significantly shorter than 24 uionths of the remaining 5 patients who received radical operation （X^2 = 5. 698, P 〈0.05 ）. Of the 42 patients with stage Ⅲ gallbladder cancer, 18 received radical operation, and the median survival time was 24 months, which was not significantly different from 18 months of the 5 patients who received extended radical operation （X^2 = 0.238, P 〉 0.05 ）. The remaining 19 patients received palliative operation, and the median survival time was 6 months, which was significantly shorter than those of patients received radical operation or extended radical operation （X^2 =5. 772, 6. 318, P 〈 0.05）. There were 47 patients with stage gallbladder cancer. Seventeen patients received extended radical operation and 30 received palliative operation, and no significant difference upon the median survival time was observed among different surgical procedures （X^2 =0.001,0.694, P 〉0.05 ）. The complication recurrence ＇after the extended radical operation was significantly higher than palliative operation （ X^2 = 6. 039, P 〈 0.05 ）. Conclusions For patients with stage I gallbladder cancer, simple cholecystectomy is preferred. Radical operation is good for patients with stage Ⅱ gallbladder cancer. The choose of radical operation or extended radical operation for patients with stage m gallbladder cancer should be based on the condition of invasion. Palliative operation could be used to patients with stage Ⅳ gallbladder cancer.