原发性胆囊癌的外科治疗

Surgical treatment of primary gallbladder carcinoma

目的探讨原发性胆囊癌病人的手术治疗方法及其治疗效果。方法回顾性分析我院1993年10月-2003年10月对66例原发性胆囊癌行外科手术治疗的临床资料。结果本组总体中位生存时间19．8个月。根治性切除术、姑息性切除术和胆道内或外引流术的生存期分别为37．8、10和2．7个月，具有非常显著性差异（P〈0.01）。根治性切除术1、3、5年生存率分别为78．2％、47．4％和26．3％，优于姑息性切除和胆道内或外引流术，具有非常显著性差异（P〈0．01）。其中，Ⅳ、Ⅴ期行扩大根治性切除术的中位生存时间平均为21个月，扩大根治性切除术明显优于姑息性切除术和胆道内或外引流术，具有非常显著性差异（P〈0．01）。结论肿瘤分期及手术根治程度是影响原发性胆囊癌疗效的主要因素，对中、晚期胆囊癌积极行扩大根治术，能改善病人的生活质量，延长生存期。

Objective To study the curative effectiveness of surgical treatments for primary gallbladder carcinoma. Methods Clinical data of 66 cases of primary gallbladder carcinoma, undergoing surgical operation from Oct. 1993 to Oct. 2003 in our hospital, were analyzed retrospectively. Results The total average survival time was 19. 8 months. The average survival time in the radical resection group,palliative resection group and laparotomy group was 37. 8, 10 and 2. 7 months, respectively（P〈0. 01 ）. Postoperative 1 ,3- and 5-year survival rate in radical resection group was 78. 2%, 47. 4% and 26. 3% respectively,which was significantly higher than that in palliative resection group and laparotomy group （P〈0. 01）. At Navin stages Ⅳ and Ⅴ the average survival time was 21 months in extended radical resection group, which was significantly higher than that in palliative resection group and laparotomy group（P〈0. 01）. Conclusion Navin stage and curative resection degree are the main related factors influencing the curative effectiveness of primary gallbladder carcinoma. The results showed extended radical resection is effective in relieving symptoms and prolonging lifespan.