手术方式与胆囊癌预后的关系分析

Analysis of the relationship between surgical procedure and prognosis of gallbladder carcinoma

目的 研究影响胆囊癌预后的因素 ,探讨手术方式与胆囊癌预后的关系。方法 回顾性分析我科自 1995年 6月 - 2 0 0 1年 6月手术治疗的 5 6例胆囊癌的临床资料 ,进行统计学分析。结果5 6例患者中男性 2 0例 ,女性 36例 ,男∶女为 1∶1.5 6。 34例合并胆囊结石。腹痛 (83.9% )和黄疸(41.1% )是主要的症状。 30例患者 (包括NevinⅡ期 5例 ,Ⅲ期 3例 ,Ⅳ期 4例 ,Ⅴ期 18例 )获得根治性切除或扩大的根治性切除 ,11例NevinⅤ期施行姑息性切除 ,行剖腹探查活检及改善症状的姑息手术者 15例。统计学分析显示术后存活时间与以下 3个因素显著相关 :手术方式、Nevin分期、是否合并胆囊结石 ;但与以下 6个因素关系不显著 :年龄、性别、病理类型、肿瘤细胞分级、术前血清胆红素、肿瘤涉及胆囊部位个数。将根治性手术以Nevin分期归类 ,Ⅱ期根治术后患者全部存活 ,Ⅲ -Ⅴ期根治术、Ⅴ期姑息性切除、Ⅴ期活检及减轻症状手术的术后生存时间之间存在统计学差别。结论 随着胆囊癌病理分期的增加 ,相应各期根治性手术的术后生存时间逐渐缩短。对于NevinⅤ期的患者 ,施行根治性切除者的术后生存时间长于姑息性切除者 ,而后者术后存活比活检及减轻症状手术者长。

Objective To explore the prognostic factors of gallbladder carcinoma and the relationship between surgical procedure and prognosis of gallbladder carcinoma. Methods A retrospective clinical analysis was made in 56 patients with gallbladder carcinoma, who underwent operation in our department from June 1995 to June 2001. Results There were 20 males and 36 females in 56 patients with a male to female ratio of 1∶1.56. 34 patients suffered from gallstones. The age ranged from 41 to 79 years old with a mean of 59.6. Abdominal pain (83.9%) and jaundice (41.1%) were the main present symptoms. 30 cases (including Nevin stage Ⅱ 5 cases, Ⅲ 3 cases, Ⅳ 4 cases, Ⅴ 18 cases) received radical or extended radical resection, non-radical resection were performed in 11 cases with Nevin stage Ⅴ and 15 cases with Nevin stage Ⅴ were subjected to biopsy with or without palliative bypass procedure. The statistical analysis showed that staging of Nevin, surgical procedure and gallstone affected postoperative survival significantly, but age, sex, preoperative serum bilirubin level, counted number of tumor location, histopathological type and grade were not significant prognostic factors. After radical resection was classified according to Nevin staging, we found that all the patients with stage Ⅱ were still alive. Meanwhile the postoperative survival periods for radical resection groups from stage Ⅲ to Ⅴ, palliative resection group and biopsy with/without palliative bypass with stage Ⅴ were significantly different. Conclusions From Nevin stage Ⅱ to Ⅴ, the survival period of each group with curative operation became shorter gradually. In those patients with stage V, the survival period of curative operation was longer than that of palliative resection. So radical resection is still the unique way to get better prognosis.