意外胆囊癌的临床病理特点及治疗方法分析

Analysis of clinicopathological characteristics and treatment on incidental gallbladder carcinoma

目的分析意外胆囊癌（incidental gallbladder carcinoma,IGBC）及术前已确诊的胆囊癌（gallbladder carcinoma,GC）这两组的临床资料、病理特点、治疗方法,以期得出早期诊断治疗胆囊癌的方法。方法回顾性分析我科2004年10月~2008年3月切除的意外胆囊癌共31例的临床资料、病理特点及治疗方法,并与同期术前已确诊的36例胆囊癌对比分析。结果在性别、腹痛、发热及黄疸等临床表现方面、术前肿瘤指标血清学检查这类指标均无统计学差异（P〉0.05）;IGBC组多合并或诊断为胆囊结石;IGBC多为T1期及Ⅰ期肿瘤,而GC组多为T3及Ⅲ期肿瘤,两者有明显统计学意义（P〈0.05）。3年存活例数显示IGBC组有较明显优势,相比GC组有统计学意义。3年后远处转移及5年存活例数比较则无统计学意义。结论 IGBC多为早期恶变,且合并胆囊结石率高,早期病例及可切除率、3年存活率相对高,预后相对好,T分期及TNM分期是IGBC显著的预后因子。

Objective To analyze the differences of clinical data, pathological characteristics and treatment between incidental gallbladder carcinoma （IGBC） group and preoperative diagnosed gallbladder carcinoma （GC）group, to explore the way of early diagnosis and treatment of gallbladder carcinoma. Methods Performed a retrospective analysis of clinical data, pathological characteristics and treatment of 31 patients who were treated from Oct 2004 to Mar 2008 in our deparment for incidental gallbladder carcinoma and to compare the materials with 36 preoperative diagnosed patients treated at the same period. Results The differences of clinical manifestation like sex, abdominal pain, fever, jaundice etc and preoperative serum tumor markers between the two groups were not statistical significance （P〉0.05）. The patients of IGBC group were often complicated and diagnosed as gallstone. IGBC group were mostly stage I, while GC group were mostly T3 and stage Ⅲ, the difference was statistical significance （P〈0.05）. IGBC group had some superiority on 3-year survival rate （P〈0.05）. But there was no difference on distant metastasis rate after 3-year and 5-year survival rate （P〉0.05）. Conclusion IGBC were mostly early malignancy and it often complicated with gallstone. Compared with GC, IGBC has more early cases, higher resectable rate, higher 3-year survival rate and better prognosis. Stage T and stage TNM is the independent prognostic factor of IGBC.