进展期胆囊癌区域化淋巴结清扫临床研究

Clinical Study of Regional Lymphadenectomy in Advanced Stage Gallbladder Carcinoma

目的探讨进展期胆囊癌区域化淋巴结清扫的方法和意义。方法回顾性分析226例确诊为进展期胆囊癌患者的临床资料,收集患者的临床资料并进行整理分析,并对患者进行随访,分析进展期胆囊癌区域化淋巴结清扫的特点及手术方法。结果 226例患者中,男性71例,女性155例,平均年龄(63.5±13.2)岁,中位年龄65岁,大部分患者胆囊有既往病史,且表现出一种或数种胆囊癌的临床症状;B超检查诊断率为51.82%;CT检查诊断率为72.19%;B超联合CT检查,诊断率为81.46%;肿瘤标志物CA199升高比例为73.89%;CA125升高比例为56.64%;CEA升高比例为38.94%;上述任意一种肿瘤标志物升高比例为91.15%;胆囊癌根治术平均淋巴结清扫个数为(9.51±3.50)个,中位个数为8个;保守治疗者术后生存时间为(16.56±3.46)个月;手术治疗者术后生存时间为(21.51±5.46)个月,两者术后生存时间比较无统计学差异(P>0.05)。结论胆囊癌根治术时,可将第八和第十三组淋巴结连同肝十二指肠韧带周围淋巴结一并清除。

Objective The method and significance of regional lymph node dissection for advanced gallbladder carcino- ma. Methods Retrospective analysis of clinical data of 226 cases diagnosed as gallbladder cancer progression and clinical data were collected and analyzed, and the patients were followed up, analysis of advanced stage gallbladder cancer regional lymph node dissection characteristics and surgical methods. Results Among the 226 patients,there were 71 males and 155 females with an average age of （63.5 ± 13.2） years and a median age of 65 years. Most patients had previous history of gallbladder and showed clinical symptoms of one or several gallbladder carcinomas. The diagnostic rate of B-ultrasound was 51.82% ;the diagnostic rate of CT was 72.19% ;B-ultrasound was 81.46% ;the tumor marker CA199 increased by 73.89% ;CA125 increased 56.64% （9.51 ±3.50） , the median number of the radical lymph node dissection was 8, and the number of the median number of tumor markers was 91.15% （16.51 ± 3.46） months. The survival time of the patients treated with operation was 21.51 ±5.46 months, and there was no significant difference between the two groups （P 〉 0.05 ）. Conclusion Gallbladder radical surgery, the eighth and thirteenth group of lymph nodes and liver duodenal ligament around the lymph nodes together to clear.