原发性胆囊癌的外科诊治与预后分析

Surgical treatment and prognosis of primary gallbladder carcinoma： a study of 197 cases

目的 总结原发性胆囊癌的临床病理特点,探讨诊断与手术方案的选择以指导原发性胆囊癌的规范化治疗.方法 回顾性分析北京协和医院1986年1月至2009年10月收住院的197例原发性胆囊癌的临床病理资料,根据手术方式及Nevin分期进行分组,应用Kaplan-Meier生存分析进行统计学处理.结果 胆囊癌的诊断主要依赖于临床表现及影像学检查,本组76.6%（151/197）的患者接受了手术治疗.统计学分析表明Nevin分期和手术方式是影响预后的独立因素;Nevin Ⅰ、Ⅱ期胆囊癌单纯胆囊切除术组与胆囊癌根治术组生存差异无统计学意义（χ2=8.932,P=0.794）,Ⅲ、Ⅳ、Ⅴ期胆囊癌根治术组患者预后优于单纯胆囊切除术组（χ2=5.221,P=0.021）,且二者均优于仅行剖腹探查组（χ2=9.76,P=0.002;χ2=4.415,P=0.036）.结论 对于Nevin Ⅰ、Ⅱ期患者,单纯胆囊切除术即已达到根治的目的;对Ⅲ、Ⅳ、Ⅴ期患者胆囊癌根治术是首选的治疗方案,但是仅行单纯胆囊切除术也能改善患者预后.

Objective To summarize the clinical and pathological characteristics of primary gallbladder carcinoma, analyze factors such as surgical procedures, tumor stages that associated with prognosis, and standardize the diagnosis and treatment strategy for primary gallbladder carcinoma.Methods From January 1986 to October 2009, 197 patients of primary gallbladder carcinoma were treated in Peking Union Medical College Hospital （PUMCH）. A retrospective study was performed basing on clinical data of these patients, statistical analysis carried out using SPSS version 13.0, Kaplan-Meier estimate employed for the survival analysis and Log-rank test for the group comparisons. Results One hundred and ninety-seven patients were enrolled （73 male and 124 female） with the mean age of 64.4±1.1years. Abdominal pain （77.3%） , obstructive jaundice （33.6%） and fever （19.5%） were the main symptoms of primary gallbladder carcinoma, with accompanying cholecystolithiasis in 99 cases. B-mode ultrasonic examination and CT scan were important for preoperative diagnosis. Nevin stages and surgical modalities were independent prognosis factors. For stage Ⅰ and Ⅱ patients the survival terms were not different between those receiving radical cholecystectomy and simple cholecystectomy. However, for stage Ⅲ, Ⅳ and Ⅴ patients the survival terms were of statistically different between those in radical cholecystectomy group and simple cholecystectomy group. Conclusions For stage Ⅰ and Ⅱ patients, simple cholecystectomy is a good surgical procedure. For those at more advanced stages, radical cholecystectomy is the choice of therapy, while simple cholecystectomy also improves the prognosis compared with laparotomy only.