肝外胆道肿瘤外科治疗远期疗效的评析(附139例随访资料)

An analysis of prospective outcome of surgical treatment for extrahepatic biliary carcinomas: a follow-up report of 139 cases

目的 探讨胆道肿瘤的临床特征、治疗方法对远期生存率的影响 ,总结胆道肿瘤的诊治经验。方法 对 1992年 1月至 2 0 0 0年 7月收治的 139例胆道肿瘤 (胆囊癌 88例 ,胆管癌 5 1例 )的临床及随访资料进行回顾分析。应用SPSS10 0统计软件包进行统计学处理。结果 88例胆囊癌的总体 5年生存率为 5 2 2 % ,5 1例胆管癌的总体 5年生存率为 2 1 6 4 %。根治切除组的 1、3、5年生存率与姑息切除组、剖腹探查组、非手术组相比均有显著性差异 (P <0 0 1) ,而姑息切除组、剖腹探查组、非手术组间的生存率无显著性差异 (P >0 0 5 )。多因素分析显示组织学分级、TNM分期及治疗方法与预后显著相关。结论 胆道肿瘤的远期疗效仍无显著改善 ;扩大根治术可望改善其预后 ,但需慎重选择病人 ;提高远期疗效的重点仍应放在肿瘤的早期诊治上。

Objective To investigate the effects of clinical features and therapeutic methods of biliary carcinomas on their prospective outcome and summarize experience in their diagnosis and treatment. Methods The clinical data of 139 patients with extrahepatic biliary carcinomas (gallbladder carcinoma in 88 and bile duct carcinoma in 51) treated in our hospital from January 1992 to July 2000 were retrospectively analyzed. All statistical analyses were performed with SPSS10.0 statistical software package. Results Amongst the 139 patients with a mean follow-up duration of 478 days, 78 received resection (radical resection in 43 and palliative resection in 35), but 30 did not. The other 31 were treated by chemo and/or radiotherapy. The overall 5 year survival rate was 5 22%, resectional rate 75% (51/68) and radical resectional rate 33 8% (23/68), respectively, in patients with gallbladder carcinoma. In patients with bile duct carcinoma, they were 21 64%, 70% (28/40) and 50% (20/40), respectively. However, there were no significant differences in these parameters between the two groups of patients (P=0.13). For either gallbladder carcinoma or bile duct carcinoma, the 1-, 3- and 5-year survival rates were remarkably higher in the radical resection group than in palliative resection, internal or external drainage and non operated groups (P<0 01). Multivariate analysis revealed that grades, T, N and M of tumor and therapeutic interventions had significantly higher risk ratios. Conclusions The long time survival of the patients with extrahepatic biliary carcinomas is not remarkably improved. With careful patient selection, radical resection may help to improve the prognosis of extrahepatic bile duct neoplasms. To improve the survival, more attention should be paid on early diagnosis and treatment.