T1、T2期胆囊癌手术方式选择

Selection of surgical methods for T1 and T2 gallbladder carcinoma

目的探讨T1、T2期胆囊癌手术方式的选择。方法回顾性分析2010年1月至2018年12月国内8家医学中心行手术治疗的139例胆囊癌患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男48例,女91例;年龄30~88岁,中位年龄64岁。T1期67例,T2期72例。术式包括单纯性胆囊切除术(SC)、单纯性胆囊切除术联合肝十二指肠韧带淋巴结清扫术(SC+L)、胆囊癌根治术(RC)。其中RC1为胆囊切除联合距胆囊床侧2 cm肝组织楔形切除,RC2为胆囊切除联合肝Ⅳb、Ⅴ段切除。生存分析采用Kaplan-Meier法和Log-rank检验。结果T1a期胆囊癌患者SC、RC1术后中位生存时间分别为64、59个月,两组术后生存差异无统计学意义(χ^2=0.088,P>0.05)。T1b期胆囊癌患者SC、SC+L、RC1术后中位生存时间分别为40、60、61个月,SC+L、RC1组术后生存优于SC组(χ^2=4.092,4.364;P<0.05),而SC+L与RC1组术后生存差异无统计学意义(χ^2=0.698,P>0.05)。T2a期胆囊癌患者RC1、RC2术后中位生存时间均为48个月,RC1、RC2组术后生存差异无统计学意义(χ^2=0.219,P>0.05)。T2b期胆囊癌患者RC1、RC2术后中位生存时间分别为33、47个月,RC2组术后生存优于RC1组(χ^2=4.370,P<0.05)。结论T1a期胆囊癌建议采用SC,T1b期采用SC+L,必要时可楔形切除肝组织,T2a期采用RC1,T2b期采用RC2。

Objective To explore the surgical approaches for T1 and T2 gallbladder carcinoma.Methods Clinical data of 139 patients with gallbladder carcinoma treated by surgery in 8 medical centers in China from January 2010 to December 2018 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,48 patients were male and 91 female,aged from 30 to 88 years old with a median of 64 years old.67 cases were classified in stage T1 and 72 cases in stage T2.The surgical procedures included simple cholecystectomy(SC),SC combined with lymphadenectomy of hepatoduodenal ligament(SC+L),and radical resection of gallbladder carcinoma(RC).RC1 was defined as cholecystectomy with wedge resection of liver tissues 2 cm from the gallbladder bed,and RC2 referred to cholecystectomy with resection of segmentⅣb andⅤ.Survival analysis was performed by Kaplan-Meier method and Log-rank test.Results The median survival time of stage T1a patients in SC,RC1 group was 64 and 59 months,respectively.No significant difference was observed between two groups(χ^2=0.088,P>0.05).The median postoperative survival time of patients with stage T1b gallbladder carcinoma in SC,SC+L,RC1 group was 40,60 and 61 months,respectively.The survival of patients in SC+L and RC1 groups were significantly better than that in SC group(χ^2=4.092,4.364;P<0.05),whereas no significant difference was noted between the SC+L and RC1 groups(χ^2=0.698,P>0.05).The median survival time of patients with stage T2a gallbladder cancer in RC1,RC2 was both 48 months,and no significant difference was observed between two groups(χ^2=0.219,P>0.05).The median survival time of patients with stage T2b gallbladder carcinoma in RC1,RC2 group was 33 and 47 months,respectively.The survival in RC2 group was better than that in RC1 group(χ^2=4.370,P<0.05).Conclusions SC is recommended for patients with stage T1a gallbladder carcinoma,SC+L for stage T1b and wedge resection can be performed when necessary.RC1 is suitable for stage T2a patients and RC2 for stage T2b patients.