胆囊癌外科治疗回顾性分析(附96例报道)

A retrospective analysis of the result of surgical treatment for gallbladder cancer: report of 96 cases

目的:探讨胆囊癌的外科治疗方法。方法:回顾性分析1999年1月-2008年10月96例原发性胆囊癌患者的手术方式及其疗效。96例患者Nevin分期:Ⅰ期2例,Ⅱ期5例,Ⅲ期9例,Ⅳ期17例,Ⅴ期63例。所有患者均行手术治疗,手术方式包括:单纯胆囊切除术(Ⅰ～Ⅲ期患者)、根治性胆囊癌切除术(Ⅱ～Ⅴ期患者)、胆囊癌扩大根治术、肝切除术、胰十二指肠切除术、姑息性手术(Ⅳ、Ⅴ期患者)。结果:96例平均住院时间为18.5d,随访时间6个月～6年,Ⅰ期和Ⅱ期7例患者仍健在,Ⅲ期4例生存期超过5年,Ⅳ、Ⅴ期术后平均存活16.4个月。51例姑息性手术患者术后平均存活6.8个月。结论:对于胆囊癌手术方式选择,与胆囊癌的分期分级密切相关,采取积极的治疗措施,如根治性或扩大根治性手术,可望延长患者的生存时间,提高患者生存质量。

Objective：To investigate the results of surgical treatment of gallbladder cancer. Methods：The clinical data of 96 patients with carcinoma of gallbladder were analyzed retrospectively. All the cases, admitted from January 1999 to October 2008, were divided into five groups by Nevin staging system： S Ⅰ 2 cases, SⅡ 5 cases, SⅢ 9 cases, SⅣ 17 casses, SⅤ 63 cases. All the patients underwent operations. Surgical operations included eholecystectomy for patients of S Ⅰ SⅢ , resection of gallbladder cancer for patients of S Ⅱ to S Ⅴ , extensive resection of gallbladder cancer, liver resection, pancreaticoduodeneetomy, or palliative surgery for patients of Ⅳ and Ⅴ. Resuits：Mean hospital stay of 96 cases was 18.5 days. Follow-up time ranged from 6 months to 6 years. Seven patients with S Ⅰ and S Ⅱ cancer were still living, 4 patients of SⅢ survived over 5 years. Mean survival time of patients of SⅣ and SV was 16.4 months after operation. Mean survival time of 51 cases who underwent palliative surgery was 6.8 months. Conclusions：The choice of operative strategy for gallbladder cancer has a close relationship with its Nevin staging. Active treatment such as radical resection of gallbladder cancer or extensive resection of gallbladder cancer may prolong the survival time and improve the quality of life of the patients with gallbladder cancer.