胆囊癌外科治疗进展:单中心10年临床研究分析

Advances in surgical management of primary carcinoma of the gallbladder:Results from 10-year research at a single institution

目的分析近10年来西安交通大学第一附属医院经意向性根治切除的原发性胆囊癌患者的临床特点及疗效,总结外科治疗经验。方法回顾性分析2008年1月至2017年12月行外科治疗的胆囊癌患者的临床资料,重点分析经意向性根治切除的患者资料,分析总收治情况、意向性根治切除率、预后情况及各临床病理特征的变化趋势。结果2008-2017年共收治胆囊癌患者2159例,经外科手术治疗患者共计1072例,其中经意向性根治手术503例;2013-2017年意向性根治手术319例,意向性根治切除率为26.5%,较2008-2012年(19.2%)明显提高(P<0.001);2008-2017年总体意向性根治切除患者中位生存时间为32月,术后1、3、5年生存率分别为68.9%、48.4%、41.6%;与2008-2012年资料相比,2013-2017年术前黄疸患者比例降低(7.8%vs.14.7%,P<0.05)、行D2淋巴清扫的患者比例明显增高(74.0%vs.26.1%,P<0.001),清扫所得总淋巴结数明显增高(8.07±5.18 vs.5.89±3.14,P<0.001),此外,R0切缘所占比例明显增高(95.6%vs.89.7%,P<0.05)。结论2008-2017年间本院胆囊癌外科意向性根治切除诊疗模式的变化主要体现在淋巴清扫范围增大、R0切除率提高及术前黄疸患者减少。

Objective To analyze the clinical characteristics of patients with primary carcinoma of the gallbladder(PGC)who underwent radical intent resection in our center in the last decade and the therapeutic effects of the operation.Methods A single-institution database of The First Affiliated Hospital of Xi'an Jiaotong University from January 2008 to December 2017 was queried for patients with PGC who had received surgical treatment.The data were studied retrospectively to assess the trend of total admission,radical resection rate,prognosis and clinicopathological characteristics of PGC in the last decade.Results A total of 2159 patients with PGC were treated in our institution from 2008 to 2017.Of them,1072 were surgically treated and 503 underwent radical intent resection.In the past 5 years(2013-2017),the radical resection rate was 26.5%(319 cases of the operation),which was significantly higher than that in 2008-2012(19.2%)(P<0.001).The overall survival time of the patients who underwent radical resection was 32 months,and the 1-,3-,and 5-year survival rate was 68.9%,48.4%and 41.6%,respectively.Compared with the data of 2008-2012,the proportion of the patients with preoperative jaundice decreased in the past 5 years(7.8%vs.14.7%,P<0.05),that of the patients who underwent D2 lymphadenectomy(74.0%vs.26.1%,P<0.001)increased significantly(P<0.001),the total number of lymph nodes obtained from the dissection(8.07±5.18 vs.5.89±3.14,P<0.001)increased significantly(95.6%vs.89.7%,P<0.05),and the proportion of R0 resection(95.6%)increased significantly(P<0.05).Conclusion The diagnosis and treatment of radical intent resection of PGC in our hospital have changed significantly in the last decade,mainly reflected in the extension of lymphadenectomy,increase in R0 resection rate and decrease in patients with preoperative jaundice.