意外胆囊癌的临床诊治与预后分析

The Diagnosis,Treatment and Prognosis of Unexpected Gallbladder Analysis

目的总结意外胆囊癌的临床、病理特征,分析不同术式及病理分期与预后的关系,指导意外胆囊癌的规范化诊疗。方法回顾性分析宁夏医科大学总医院2009年1月至2013年12月5年间收治的29例意外胆囊癌的临床资料,应用Kaplan-Meier法对比分析不同手术方式及病理分期间患者的累积生存率,分析相关因素与患者累积生存率的关系。结果 29例患者术前诊断为胆囊结石、胆囊炎20例,胆囊结石合并息肉1例(均为多发),胆囊息肉1例,胆囊结石合并胆总管结石6例,妇科术中诊断1例;按Nevin分期,I期2例,II期2例,III期11例,IV期5例,V期9例;其中腺癌23例(高分化3例,高-中分化6例,中-低分化5例,中分化4例,低分化5例),乳头状腺癌1例,乳头状腺癌合并腺癌1例,粘液腺癌1例,鳞癌1例,腺瘤癌变1例,腺癌合并粘液腺癌1例。胆囊癌根治术组患者累积生存率明显好于单纯胆囊切除术组(P<0.05);Nevin I、Ⅱ期患者预后显著优于III、IV、V期(Kaplan-Meier存活率Long-rank检验,I、II期vs III、IV、V期,P<0.05)。结论意外胆囊癌临床表现缺乏特异性,早期诊断困难;外科医师要提高意外胆囊癌意识,术中及时送冰冻病理协助诊断;对确诊的意外胆囊癌患者,应首选胆囊癌根治术。

Objective To summarize the clinical and pathological features of the unexpected gallbladder,and to analyze the different operative methods and the relationship between the pathological staging and prognosis,and standardize the diagnosis and treatment strategy of incidental gallbladder carcinoma. Methods Between January 2009 and December 2013,29 incidental gallbladder carcinoma patients were treated in the General Hospital of Ningxia Medical Univercity. A retrospective study was performed based on the clinical data of these patients to evaluate the Cumulative survival rate of patients between different ways of operation and pathological staging in patients with Kaplan- Meier methods. Results The preoperative diagnosis of 29 cases was： 20 patients with gallbladder stones,cholecystitis; 1 case with the gallbladder stone and gallbladder polyps（ both for multiple）; gallbladder polyp in 1 case; gallbladder stone with common bile duct calculi in 6 cases; 1 case was in Intraoperative diagnosis of Dept. of gynaecology. Two cases were on the stage of Nevin I,2 on Nevin II,11 on Nevin III,5 on Nevin IV and 9 on Nevin V. In this group,adenocarcinoma 23 cases（ 3 high- differentiation,6 high- moderate- differentiation,5low- moderate- differentiation,4 moderate- differentiation,5 low-differentiation）,papillary adenocarcinoma 1 case,papillary adenocarcinoma merger adenocarcinoma 1 case,mucous adenocarcinoma 1 case,squamous cell carcinomas 1 case,adenoma canceration 1 case,adenocarcinoma merger mucous adenocarcinoma 1 case. The survival terms were of statistic significance between the radical cholecystectomy groups and simple cholecystectomy groups（ P = 0. 036）; The prognosis of patients on stages I,II are better than those who are on stages III,IV,V（ Kaplan Meier survival Long- rank test,stages I,II vs III,P〈0. 05,stage III vs IV,P〈0. 05）. Conclution The clinical manifestations of the Unexpected gallbladder are lack of specificity,so the early diagnosis is difficult. Surgeons shoud raise awareness of unexpected gallbladder and send frozen pathology diagnose in time. To the confirmed cases,surgical operation is the first choice of therapy.