胆囊癌不同外科诊治方法的生存分析

Comparison of survival of patients with gallbladder cancer undergoing different surgical procedures

目的探讨胆囊癌的外科诊治经验。方法回顾性分析郑州大学第一附属医院肝胆外科治疗的47例胆囊癌患者的临床资料。结果早期胆囊癌(NevinⅠ~Ⅱ期)患者的5 a生存率为100%,随着胆囊癌Nevin分期的增加,5 a生存率降低(Ⅲ期为46.2%,Ⅳ~Ⅴ期为0)。不同术式对非早期胆囊癌患者生存率影响较大,采用根治术患者1 a、3 a、5 a生存率分别为81.8%、54.5%和36.4%,均分别高于姑息术患者的23.1%、0和0,差异有统计学意义(P<0.05)。采用扩大根治术患者1 a、3 a、5 a生存率分别为75.0%、37.5%和25.0%,姑息术患者分别为23.1%、0和0。1 a和3 a差异均有统计学意义(P<0.05),5a的差异无统计学意义(P>0.05)。采用根治术和扩大根治术患者的生存率差异均无统计学意义(P>0.05)。结论早期诊断且合理的手术方案可增加胆囊癌患者的生存率。

Objective To discuss the surgical diagnosis and treatment experience of gallbladder carcinoma. Methods A retrospective analysis was made on clinical materials,surgical ways and prognosis conditions of 47 patients with gallbladder carcinoma that had received surgical treatment in the department of hepatobiliary surgery,First Affiliated Hospital of Zhengzhou University. Results Five-year survival rate of early gallbladder carcinoma( Nevin stage Ⅰ ~ Ⅱ) was 100%; with the increase of Nevin staging of gallbladder carcinoma,five-year survival rate of patients decreased( stage Ⅲ vs stage Ⅳ ~ Ⅴ: 43. 2% vs 0). Different surgical ways have a big influence on survival rate of patients with non-early gallbladder carcinoma. The one-year,three-year and five-year survival rates of patients receiving radical operation were all higher than that of patients receiving palliative resection( 81. 8% vs 23. 1%,54. 5% vs 0,36. 4% vs 0),and the differences all had statistical significance( P < 0. 05). The one-year,three-year and five-year survival rates of patients receiving extended radical operation were all higher than that of patients receiving palliative resection( 75. 0% vs23. 1% 、37. 5% vs0、25. 0% vs0),the one-year and three-year differences all had statistical significance( P < 0. 05) and the difference in five-year survival rate had no statistical significance( P > 0. 05).The difference in survival rate of patients receiving radical operation and patients receiving extended radical operation had no statistical significance( P > 0. 05). Conclusion Early diagnosis and reasonable surgical plan can increase the survival rate of patients with gallbladder carcinoma.