摘要
目的 分析77例意外胆囊癌临床资料,探讨肿瘤TNM分期及二次手术的时间选择对患者术后生存期的影响.方法 选取2008年1月至2013年1月西安交通大学第一附属医院肝胆外科及延安大学咸阳医院肝胆外科符合统计要求的意外胆囊癌病例77例,统计分析TNM分期及行二次手术与初次胆囊切除术间隔时间,分析其与生存期的关系.结果 本组77例患者,男15例,女62例,平均年龄为（57.3±8.6）岁,术前表现无特异性.患者初次手术包括腹腔镜手术53例,开腹手术24例.77例患者中26例为术中冰冻病检发现,随即根据胆囊癌TNM分期行胆囊癌根治术、姑息性手术或胆道引流术等,平均生存时间为（622±113.7） d;51例术后病理确诊患者中46例行二次手术,其中43例患者于术后14 d内行二次手术,平均生存时间为（456±62.9）d.对术中发现及术后14 d内行二次手术的意外胆囊癌患者进行生存分析,发现二者间生存时间差异无统计学意义（P＞0.05）.结论 意外胆囊癌的预后不仅与胆囊癌本身的临床分期有关,也与二次手术时机有关.两次手术时间间隔小于两周者与术中发现立即行手术治疗者相比,二者预后无明显差别;对于已属晚期的胆囊癌,也应根据患者一般状况选择行引流术等姑息性手术,以期提高患者的生存质量.
Objective To analyse the clinical data of 77 patients with unsuspected gallbladder carcinoma,and to determine the impact of TNM stage and the timing of the second operation on postoperative survival.Methods A retrospectively analysis of 77 patients operated between January 2008 and January 2013 in our hospital for unsuspected gallbladder carcinoma was carried out.The case inclusion criteria was in strict accordance with the medical records which described ＂without preoperative diagnosis,or cholecystectomy for benign gallbladder diseases,or intraoperative or postoperative pathological diagnosis of gallbladder cancer＂.References to previous published medical literature and the intervals from initial cholecystectomy to further treatment were analyzed to see whether the prognosis and survival varied depending on the TNM staging and whether secondary radical surgery was carried out.Results For the 77 patients in this study,they all had high risk factors associated with gallbladder cancer which included：women,aged 〉 50 and gallbladder stones.The initial surgery included laparoscopic cholecystectomy （n =53）,and open cholecystectomy （n =24）.In 26 patients,intraoperative frozen section confirmed the diagnosis and they were treated according to the TNM staging （radical operation n =7,palliative surgery n =17）.The postoperative 1-,2-,3-year cumulative survival rates were 65%,45% and 20%,respectively.For the 54 patients who underwent radical or extended radical cholecystectomy within a short interval from the first operation,the 1-,2-,3-year cumulative survival rates were 82.5%,62.5% and 45.7%,respectively.Conclusions For resectable gallbladder cancer,the prognosis of unsuspected gallbladder carcinoma was related not only to the clinical staging,but also to the timing of the radical operation.The shorter time interval,the longer the survival,and the better the prognosis.There was no significant difference in prognosis for the group of patients with time intervals between the two operations of less than two weeks when compared with the group with immediate radical surgery.For advanced stages of gallbladder cancer,palliative surgery should be given according to the patient＇s general condition,aiming to improve quality of life.
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2015年第1期35-38,共4页
Chinese Journal of Hepatobiliary Surgery
关键词
胆囊癌
意外胆囊癌
术后生存期
二次手术
Gallbladder carcinoma
Unsuspected gallbladder carcinoma
Postoperative survival
Second surgery
