摘要
目的总结原发性胆囊癌的临床特征和外科治疗经验,探讨不同的治疗方式对其预后的影响,并对影响其预后的因素进行分析。方法回顾我院2000年6月至2007年6月收治的113例胆囊癌的临床资料,分析肿瘤分期、外科手术方式等相关因素与预后之间的关系。结果 103例患者获随访,患者平均生存时间(19.6±18.4)个月,1、3、5年生存率分别为55.0%、25.0%、8.0%;根治性切除组患者1、3、5年生存率分别为81.0%、42.0%、19.0%,与姑息手术组、剖腹探查组比较差异有统计学意义(P<0.05);其中扩大根治者生存(16.2±3.7)个月,明显长于姑息性切除术者的(9.2±1.1)个月(P<0.05)。Cox多因素分析显示,肿瘤的浸润深度、淋巴结转移、远处转移和治疗方法与胆囊癌的预后独立相关。结论胆囊癌的早期症状不典型,早期发现率低,早期诊断和手术是提高胆囊癌预后的关键。高危患者可适当放宽胆囊切除的指征,对未能手术的高危患者应定期随访、严密监测;对晚期胆囊癌应行积极的、个体化的综合治疗,根治术或扩大根治术是提高患者长期生存率的有效手段。
Objective To evaluate the correlation between pancreatic-phase CT enhancement and histopathological grades,intratumoral microvessel density（MVD） and expressions of vascular endothelial growth factor（VEGF） in pancreatic carcinoma.Methods Thirty patients with pancreatic carcinoma underwent CT scanning before resection.The enhancement degrees and forms of tumor were observed in pancreatic-phase.The operative sample was stained with HE and marked with immunohistochemistry,and the histopathological grades,MVD and expression of VEGF of pancreatic carcinoma were examined.The correlation of CT enhancement of the tumor and the pathological grades,MVD counting in hot spots areas of neoplastic parenchyma cells,expression of VEGF of pancreatic carcinoma were comparatively analyzed.Results CT enhancement of tumor was inversely proportional to the malignant degree of pancreatic carcinoma（r=0.733,t=5.708,P0.001） and the MVD counting in the hot spot areas of tumor（r=0.778,t=6.551,P0.001）.The pathological grade positively correlated with MVD（r=0.437,t=7.574,P0.05）,and have no correlation with VEGF expression（r=-0.240,t=-1.306,P0.05）.Mean MVD in group with positive expression of VEGF was 57.7±11.1,which in group with negative VEGF expression was 44.6±12.2（t=3.018,P0.05）.Conclusion The extent of CT en-hancement is highly related to the malignant degree of pancreatic carcinoma and the MVD counting in the hot spot areas of tumor.The malignant degree of pancreatic carcinoma and VEGF expression are highly related to the MVD counting.
出处
《肝胆胰外科杂志》
CAS
2010年第5期398-401,共4页
Journal of Hepatopancreatobiliary Surgery
关键词
原发性胆囊癌
诊断
治疗
根治术
pancreatic neoplasms pathology microvessel density vascular endothelial growth factor tomography X-ray computed
