胆囊癌不同手术方式的疗效分析

Therapeutic effets of different surgical procedures for the treatment of gallbladder cancer

目的 探讨胆囊癌不同手术方式的疗效.方法 回顾性分析2000年1月至2009年10月四川大学华西医院收治的81例胆囊癌患者的临床资料,分析胆囊癌患者采用不同治疗方式的疗效,肿瘤不同浸润深度与淋巴结转移的关系.采用Kaplan-Meier法进行生存分析,生存率比较采用Log-rank法.结果 Ⅰ、Ⅱ、Ⅲ、Ⅳ期胆囊癌患者中位生存时间分别为68、18、7、5个月,1、3、5年生存率分别为100%、80%、60%,57%、29%、14%,27%、7%、0,11%、4%、0.不同TNM分期患者的生存率比较,差异有统计学意义（P＜0.05）.本组81例胆囊癌患者中,67例行手术治疗,T1b期患者中,行标准根治术和单纯胆囊切除术的5年生存率分别为100%和0.Ⅱ期患者中,行标准根治术和单纯胆囊切除术的中位生存时间分别为45个月和12个月,1、3、5年生存率分别为67%、33%、33%和50%、0、0,两者比较,差异有统计学意义（P＜0.05）.Ⅲ期患者中,行标准根治术的1、3、5年生存率分别为33%、17%、6%,行扩大根治术的生存时间均超过12个月,而行其他治疗方式的生存时间均未超过12个月.Ⅳ期患者中,行扩大根治术和标准根治术的1、3、5年生存率分别为38%、12%、0和14%、0、0,行其他治疗方式的生存时间均未超过12个月.行淋巴结清扫的2例T1期患者均未出现淋巴结转移;15例T2期患者中7例出现淋巴结转移;14例T3期患者中7例出现淋巴结转移,其中1例出现N2站转移;13例T4期患者中12例出现淋巴结转移,其中4例出现N2站转移.结论 肿瘤浸润深度影响淋巴结转移.T1b、Ⅱ、Ⅲ期胆囊癌患者需行胆囊癌根治术.Ⅳ期胆囊癌患者行扩大根治术并发症发生率虽然较高,但与其他治疗方式比较,患者可获得更长的生存时间.

Objective To investigate the therapeutic effects of different surgical procedures for the treatment of gallbladder cancer. Methods The clinical data of 81 patients with gallbladder cancer who were admitted to the West China Hospital of Sichuan University from January 2000 to October 2009 were retrospectively analyzed.The efficacies of different surgical procedures for the treatment of gallbladder cancer, and the relationship between T stage and lymph node metastasis were investigated. The postoperative survival rates of patients in different TNM stages were analyzed and compared using the Kaplan-Meier method and Log-rank test, respectively. Results The median survival times of patients in stage Ⅰ , Ⅱ ,Ⅲ and Ⅳ were 68, 18, 7 and 5 months, respectively. The 1-,3-, 5-year survival rates were 100%, 80% and 60% for patients in stage Ⅰ, 57%, 29% and 14% for patients in stage Ⅱ, 27%, 7% and 0 for patients in stage Ⅲ and 11%, 4% and 0 for patients in stage Ⅳ. There were significant differences in the survivals of patients in different TNM stages （ P ＜ 0.05 ）. Of the 81 patients, 67 received surgical treatment. The 5-year survival rate was 100% for patients in stage T1b who received standard radical resection and 0 for patients who received simple cholecystectomy. The median survival time was 45 months for patients in stage Ⅱ who received standard radical resection and 12 months for patients in stage Ⅱ who received simple cholecystectomy, and their 1-, 3-, 5-year survival rates were 67%, 33%, 33% and 50%, 0, 0, respectively, with significant differences （ P ＜ 0. 05 ）. The 1-, 3-, 5-year survival rates of patients in stage Ⅲ who received standard radical resection were 33%, 17% and 6%, respectively. The survival time of patients who received extended radical resection was longer than 12 months, while the survival time of patients who received standard radical resection or other palliative therapy was shorter than 12 months. The 1-, 3-, 5-year survival rates of patients in stage Ⅳ who received extended radical resection and standard radical resection were 38%, 12%, 0and 14%, 0, 0, respectively. The survival time of patients in stage Ⅳ who received other treatments was shorter than 12 months. Lymph node metastasis were identified in 7 patients in stage T2（n = 15）, 7 patients in stage T3（n = 14）, and 12 patients in stage T4（n = 13）, no patient in stage T1 （n =2） was found with lymph node metastasis. Conclusions Lymph node metastasis is significantly influenced by the depth of invasion of the gallbladder cancer. For patients in stage T1b, Ⅱ and Ⅲ, radical resection of gallbladder cancer is necessary; for patients in stage Ⅳ, although the incidence of complication is higher, the survival time is much longer when compared with other treatments.