不同大小胆囊结石与胆囊癌患病危险度的研究

Relative risk for gallbladder cancer in patients with gallstones of different sizes

目的探讨不同大小胆囊结石病人患胆囊癌的相对危险度(RR)。方法收集胆囊癌病人154例为病例组,再为每一病例挑选2个与之匹配的非胆囊癌病例构成对照组,共308例。据此计算不同大小胆囊结石病人患胆囊癌的 RR 及其95%可信区间(95%CI)。结果与结石最大径<1cm 组相比,≥2cm 的 RR=4.8,95%CI=2.326～9.932;>13cm 的 RR=5.810,95%CI=2.206～15.305;结石最大径≥2cm 对于<2cm 的 RR=4.254,95%CI=2.206～7.436。95%CI 均不包括 RR=1的点,具有统计学意义。上述各组间病例组与对照组的分布差异显著(x^2检验,P<0.001),与95%CI 的判断相一致。结论结石>2cm 患癌的 RR 是<2cm 的5倍。据此建议≥2cm 的无症状结石应作为患癌的高危倾向和施行胆囊切除的参考依据。

Objective To investigate the relative risk of gallbladder cancer in patients suffering from gallstones of dif- ferent sizes.Method The relative risk(RR) for gallbladder cancer of different gallstone sizes was estimated by case-control study,using 118 patients with gallbladder cancer and 259 controls.Result The RR was 4.807, and the 95% confidence interval(95%CI) was 2.326～9.932,when stones with the maximum diameter≥2cm was compared with those<1cm;the RR was 5.810,95%CI2.206～15.305,for stone size≥3cm vs<1cm. It revealed that when the gallstone diameter increased from<1cm to≥2cm,the relative risk for gallbladder can- cer increased by about five times.Conclusion We suggest that cholecystectomy should be recommended to the patients with silent gallbladder stone with size≥2cm.