意外胆囊癌临床治疗预后多因素对照分析

Clinical prognostic multivariate analysis of incidental gallbladder cancer： a case controlled retrospective study

目的 探讨意外胆囊（IGBC）治疗预后的危险因素及评价腹腔镜胆囊切除术（LC）对IGBC治疗预后的影响.方法 回顾性分析2001年1月至2008年12月期间55例IGBC腺癌患者的临床资料.按不同手术方式将其分成3组,即腹腔镜组（n=23）、转开腹组（n=6）和开腹组（n=26）.运用生存分析及Cox回归模型比较组间生存率差异及了解IGBC预后的相关危险因素.结果 全组术后1、3、5年生存率分别为74.3%、47.7%、35.8%,中位生存期为36个月.各组生存率的差异无统计学意义（P＞0.05）.Cox回归分析结果显示,病理T分期是影响IGBC预后的独立危险因素（OR=2.75,P=0.00）;随着肿瘤浸润深度的增加,患者的牛存预后明显变差.而手术方式、切口种植等因素与预后无关（P＞0.05）.结论 IGBC预后与病理T分期有关,而LC对IGBC的治疗预后与开腹胆囊切除术相比无差异.

Objective To investigate the prognostic risk factors in incidental gallbladder cancer （IGBC） and evaluate the effect of laparoscopic cholecystectomy（LC） applied in treating IGBC. Methods The retrospective study enrolled 55 patients with incidental gallbladder adenocarcinoma treated between January 2001 and December 2008. The patients were divided into three groups according to different surgical approaches; laparoscope group （n = 23）, conversion group （n = 6 ） and laparotomy group （n = 26）. Survival analysis and Cox regression model were applied to comparing the difference of survival rate between three groups and to analyzing the related prognostic risk factors of ICBC. Results The overall 1-,3- and 5-year survival rates were 74. 3% , 47. 7% and 35. 8% respectively. And the median survival time was 36 months. The outcome of survival rate between three groups was not different statistically. Cox regression analysis indicated that pathologic T stage was an independent risk factor influencing IGBC（ OR = 2. 75, P =0. 00）. The prognosis was getting worse according to the rising depth of tumor invasion. However, the other factors, such as surgical approach, tumor incisional implantation, ect. were not related to the prognosis （ P ＞0. 05）. Conclusion The factor of pathologic T stage is related to the prognosis of IGBC for which LC,compared with open cholecystectomy, should not be regarded as a negative factor in treatment.