T2期胆囊癌区域淋巴结清扫的范围

Selection of range of regional lymphadenectomy for patients with T2 gallbladder cancer

目的 探讨区域淋巴结清扫范围对T2期胆囊癌患者预后的影响.方法 回顾性分析1990年1月至2009年12月上海交通大学医学院附属新华医院48例施行胆囊癌根治术的T2期胆囊癌患者的临床资料.根据术中淋巴结清扫范围分为：标准组（23例）,行标准区域淋巴结清扫（清扫胆囊管、胆总管周围及肝十二指肠韧带等部位的淋巴结）;扩大组（25例）,行扩大区域淋巴结清扫（清扫肝十二指肠韧带、胰头周围、十二指肠周围、门静脉周围、肝总动脉旁、腹腔干等部位的淋巴结）.总结不同范围淋巴结清扫对T2期胆囊癌患者的治疗效果,采用Fisher确切概率法分析并发症发生率,Kaplan-Meier法进行生存分析,生存率的比较采用Log-rank法.结果 两组患者均无围手术期死亡.标准组患者并发症发生率为17%（4/23）,扩大组患者并发症发生率为24%（6/25）,两组比较,差异无统计学意义（P＞0.05）.标准组患者5年累积生存率为40%,中位生存时间为29.8个月;扩大组患者5年累积生存率为66%,中位生存时间为53.2个月,两组比较,差异有统计学意义（x2=4.687,P＜0.05）.结论 T2期胆囊癌患者在原发病灶能够根治性切除的基础上,应该行扩大区域淋巴结清扫.

Objective To investigate the efficacy of regional lymphadenectomy for patients with T2 gallbladder cancer. Methods From January 1990 to December 2009, 48 patients with T2 gallbladder cancer received regional lymphadenectomy following radical surgery at the Xinhua Hospital of Shanghai Jiaotong University, and their clinical data were retrospectively analyzed. Patients were divided into two groups according to the range of lymphadenectomy. Standard group （23 patients）： lymph nodes in the regions of bile duct, common bile duct and hepatoduodenal ligament were dissected; extended group （25 patients）： lymph nodes in the regions of hepatoduodenal ligament, head of pancreas, duodenum, portal vein, common hepatic artery and celiac axis were dissected）.The condition of patients in the two groups were compared after the treatment. The morbidity and survival rate were analyzed by using Fisher exact test and Kaplan-Meier method, respectively, and the survival rates between the two groups were compared by using Log-rank test. Results No perioperative death was found in the two groups. The morbidities was 17% （4/23） in the standard group and 24% （6/25） in the extended group, with no significant difference between the two groups （ P ＞ 0.05 ）. The 5-year cumulative survival rate and median survival time were 40% and 29.8 months in the standard group, and 66% and 53.2 months in the extended group, with significant differences between the two groups （ x2 = 4. 687, P ＜ 0.05 ）. Conclusion Extended regional lymphadenectomy should be performed on patients with T2 gallbladder cancer if the primary lesions can be dissected radically.