56例原发性胆囊癌的手术方式及生存期的分析

Effect of the Surgical Modes on Survival Analysis in 56 Cases with Primary Gallbladder Carcinomas

目的探讨不同外科治疗方式对原发性胆囊癌生存期的影响。方法对宁夏医科大学总医院2006年1月-2011年5月行手术治疗并经病理检查证实的56例原发性胆囊癌的临床资料进行回顾性分析。按照国际抗癌联盟(UICC 2000)TNM分期:0期3例,Ⅰ期12例,Ⅱ期17例,Ⅲ期11例,Ⅳ期13例;单纯胆囊切除术3例,胆囊癌根治术18例,胆囊癌扩大根治术16例,胆囊姑息切除术加内或外引流术10例,剖腹探查及肿块活检及外引流术9例。结果 45例获随访,平均随访时间为465.7d。TNM的不同分期病例所行术式不同,其预后也不同。其中TNMⅢ期行胆囊癌扩大根治术组患者中位生存期为413d,明显长于TNMⅢ期行姑息性切除术者的237d(P<0.05);TNMⅣ期行胆囊癌姑息性手术的生存期中位数为305d,长于行剖腹探查T管引流术的生存期中位数107d(P<0.05),结论根据胆囊肿瘤临床UICC分期选择合理的手术方式对患者生存期影响大,提高胆囊癌临床UICC分期的准确率,可对术者手术方式的选择及切除范围起到指导性作用。

Objective To explore effect of the different surgical modes on survival time in patients with prima- ry gallbladder carcinoma. Methods 56 eases with primary gallbladder carcinomas undergone surgical treatment and pathological diagnosis were analyzed retrospectively from January 2006 to May 2011. In accordance with UICC 2000 TNM staging system,3 cases were at stage 0,12 cases at stage Ⅰ ,17 cases at stage Ⅱ,11 cases at stage m , 13 cases at stage IV. 3 cases performed simple cholecystectomy in, 18 cases radical resection of gallbladder carcinoma,extended radical resection of gallbladder carcinoma in 16 cases, palliative resection plus drainage drainage within or outside of gallbladder carcinoma in 10 cases, tumor biopsy, laparotomy and external of gallbladder carcinoma in 9 cases. Results Forty - five patients were followed - up and the mean follow- up period of 465.7 days. The mean survival days ,which were significantly higher than those in period of gallbladder radical resection group was 783.3 palliative operation group and laparotomy biopsy group（P 〈 0. 05 ）. An average survival period of extended radical resection of gallbladder carcinoma patients was 413 days, which was significantly longer than those of palliative operation of 237 days （P 〈 0.05）. Conclusion Choosing the surgical approach based on UICC clinical stage can make a huge impact on patient survival period. UICC staging system can improve the accuracy of clinical diagnosis and guide the choice of surgical resection.