不同术式对Ⅳ期胆囊癌生存状况比较分析

Comparative analysis of different surgical procedures on the survival of patients with stage Ⅳgallbladder carcinoma

目的探究不同外科手术对于Ⅳ期胆囊癌患者的治疗效果和对生存状况的影响。方法回顾性分析2011年1月至2012年1月接受手术治疗的142例Ⅳ期胆囊癌患者资料,其中38例接受扩大根治术的患者为A组,27例接受胆囊全切术的患者为B组,31例接受姑息切除术的患者为C组,46例接受胆道内外引流术的患者为D组。对所有患者进行为期3年的术后随访,采用SPSS19.0软件进行统计学分析,比较4组患者治疗后1年、2年、3年生存率、中位生存时间。各组中位生存时间结果比较采用t检验,计数资料比较用χ~2检验,生存率比较用Kaplan-Meier检验,P<0.05为差异具有统计学意义。结果对于Ⅳa期胆囊癌患者,A组患者生存状况更优,其1年生存率为63.2%、2年生存率为34.2%、3年生存率为10.5%,中位生存时间为(18.7±2.9)个月。A组1年生存率与B组差异不大,但2、3年生存率以及中位生存时间较B组更长。A、B组的1年、2年、3年生存率均高于C、D组;且中位生存时间也较高,A、B组与C、D组相比差异具有统计学意义(t=2.215,P=0.036)。对于Ⅳb期患者,4组患者1年、2年、3年生存率无统计学差异,但A组患者较其他3组患者中位生存时间更长。A组1年生存率21.1%、2年生存率10.5%、3年生存率2.6%,中位生存时间(11.3±3.4)个月。4组患者中位生存时间比较差异具有统计学意义(t=2.189,P=0.036)。结论对于Ⅳa期胆囊癌患者扩大根治术以及胆囊全切术比其他手术方式效果更优,尤其是扩大根治术能够更好的提高Ⅳa期患者生存状况。对于Ⅳb期胆囊癌患者采用扩大根治术则可以提高患者的中位生存时间,因此临床上对于Ⅳ期胆囊癌患者可以采用扩大根治术为主要外科治疗方式。

Objective To explore the clinical outcome of different surgical procedures for patients with stage Ⅳ gallbladder carcinoma. Methods From January 2011 to January 2012, 142 patients with stage Ⅳ gallbladder cancer, who underwent surgery, were enrolled in this study, including 38 patients received extended radical resection of gallbladder carcinoma in group A, 27 patients received cholecystectomy in B group, 31 patients received palliative resection in C group, 46 patients received biliary drainage in D group. All patients were followed up for a period of three years. Clinieal data were analyzed by using statistical software SPSS 19. 0. Measurement data such as median survival time were examined by using t test. Count data were examined by using χ2 test. 1 years, 2 years, 3 years survival rate and median survival time were compared between 4 groups by using Kaplan-Meier test. A P value 〈 0.05 was considered as statistically significant difference. Results Compared with other 3 groups, for patients with stage Ⅳ a gallbladder cancer in group A had better survival, with a 1 year survival rate of 63.2% , a 2 year survival rate of 34.2% , 3 year survival rate of 10.5% , and a median survival time of （ 18.7 ± 2.9 ） months. The 1 year survival rate of A group was not significantly different from that of B group, however 2- and the 3-years survival rate and the median survival time in A group were longer than those in B group respectively. 1-, 2-, 3-years survival and the median survival time in A, B group were higher than those in C, D group respectively with significant difference （ t = 2. 215, P = 0. 036 ）. for patients with stage Ⅳ a gallbladder cancer, there were no significant difference in terms of 1-, 2- and 3-years survival rate among 4 groups,however the median survival time in A group was longer than those in other 3 groups. In A group, 1-year survival rate of 21.1%, 2-year survival rate of 10.5%, 3-year survival rate of 2. 6%, median survival time （ 11.3 ± 3.4） months were observed. There were significant difference in temas of median survival time among 4 groups （t = 2. 189, P = 0. 036）. Conclusion For patients with stage Ⅳa gallbladder carcinoma, extended radical resection of gallbladder carcinoma and cholecystectomy are better than other surgical methods, especially the radical operation could improve postoperative survival. For patients with stage Ⅳb gallbladder cancer, extended radical resection of gallbladder carcinoma could improve the median survival time. Therefore, extended radical resection could be used as the main surgical treatment for patients with stage Ⅳ gallbladder cancer.