意外胆囊癌的临床特征分析

Clinical characteristics analysis of incidental gallbladder cancer

目的系统评价胆囊切除术中或术后发现意外胆囊癌的临床特征。方法在Pubmed、Embase和Cochrane数据库中检索数据,最终选择了16篇文章进行荟萃分析,了解意外胆囊癌的发生率、T分期的分布以及根治性手术的比例。结果最终汇总1022例意外胆囊癌患者。在术前诊断为良性胆囊疾病的胆囊切除术中,意外胆囊癌的发生率为0.004(95%CI:0.003~0.004)。意外胆囊癌T_(2)期比例最高,为0.402(95%CI:0.372~0.433),其次T_(3)期为0.258(95%CI:0.230~0.285)。以治愈为目的再次手术的患者比例为0.411(95%CI:0.303~0.530)。在再次手术中无法切除的患者比例为0.089(95%CI:0.042~0.180)。结论大部分的意外胆囊癌处于T_(2)期和T_(3)期。对于T_(2)期及以上分期的胆囊癌,进行根治性胆囊癌切除是必要的。

Objective To systematically evaluate the clinical diagnostic and therapeutic characteristics of incidental gallbladder cancer discovered during or after cholecystectomy.Methods Data were retrieved from Pubmed,Embase and the Cochrane Library.Sixteen articles were ultimately selected for meta-analysis to investigate the incidence of incidental gallbladder cancer,the distribution of T staging and the proportion of radical surgeries.Results A total of 1022 cases of incidental gallbladder cancer were included in the analysis.The incidence of incidental gallbladder cancer in cholecystectomy for preoperative diagnosis of benign gallbladder disease was 0.004(95%CI:0.003-0.004).T_(2) stage accounted for 0.402(95%CI:0.372-0.433)of incidental gallbladder cancers.T_(3) stage accounted for 0.258(95%CI:0.230-0.285).The proportion of patients undergoing reoperation for curative purposes was 0.411(95%CI:0.303-0.530).The proportion of patients in whom reoperation was not feasible was 0.089(95%CI:0.042-0.180).Conclusion Most incidental gallbladder cancers were in T_(2) and T_(3) stages.Radical cholecystectomy is necessary for gallbladder cancer staged T_(2) and above.