胆囊癌临床分期及手术方式与预后的关系

The relationship among prognosis and clinical stage, operation mode of gallbladder carcinoma

目的评价胆囊癌Nevin分期、手术方式与预后的关系。方法1992年10月至2002年12月间,新华医院手术治疗的82例胆囊癌患者,记录Nevin分期、手术方式及术后生存情况。结果在行根治术或扩大根治术的47例中淋巴结阳性者38例(80.85%),其中包括3例Ⅱ期、30例Ⅳ期、5例Ⅴ期。侵犯胆囊壁全层的胆囊癌(Ⅲ期+Ⅳ期)中淋巴结转移率为83.3%(30/36)。4例行单纯胆囊切除的Ⅰ期患者长期生存。而行单纯胆囊切除的4例Ⅱ期患者及1例Ⅲ期患者存活均未超过3年。行胆囊癌根治术的4例Ⅱ期、1例Ⅲ期及行胆囊癌扩大根治术3例Ⅳ期患者生存5年以上。行扩大根治术的Ⅴ期及剖腹探查病例3年、5年生存率为0。结论胆囊癌的分期、手术方式与术后生存率有显著关系,Ⅰ期可行单纯胆囊切除,Ⅱ、Ⅲ期胆囊癌应行根治切除手术,Ⅳ期胆囊癌应行扩大根治手术,Ⅴ期患者行扩大根治手术无效。

Objective To evaluate the relationship among prognosis, clinical stage and operation mode of gallbladder carcinoma. Methods From October 1992 to December 2002, a total of 82 patients with gallblad,＂der carcinoma underwent operation in Xinhua hospital. Nevin stage, operation mode and postoperative survival condition were noted. Results The positive rate of lymph node was 80.85% in 47 cases with radical resec,＂tion and extended radical resection, including 3 case of stage Ⅱ, 30 cases of stage Ⅳ and 5 cases of stage Ⅴ. In all cases with stage Ⅲ and Ⅳ, the positive rate of lymph node was 83.3% （30/36）. Four cases with stage Ⅰ undergone simple cholecystectomy were alive more than 5 years. Four cases with stage Ⅱ and 1 case with Ⅲ undergone simple cholecystectomy died within 3 years. Four cases with stage Ⅱ and 1 case with stage Ⅲ undergone radical cholecystectomy were alive more than 5 years. Three cases with stage Ⅳ un,＂dergone extended radical cholecystectomy were alive more than 5 years. The 3-year, 5-year survival rate in all cases with stage Ⅴ undergone extended radical resection and laparotomy were zero. Conclusion The postoperative survival rate is significantly affected by the clinic stage and operation mode of gallbladder carci,＂noma. The simple cholecystectomy is enough for stage Ⅰ. Radical resection should be performed in the cases with stage Ⅱ and Ⅲ. Extended radical resection should be performed in cases with stage Ⅳ. In the cases with stage Ⅴ, the benefit of extended radical resection seems limited.