中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
CHINESE JOURNAL OF DIGESTIVE SURGERY
2011年
2期
96-99
,共4页
胆囊肿瘤%手术方式%淋巴结转移
膽囊腫瘤%手術方式%淋巴結轉移
담낭종류%수술방식%림파결전이
Gallbladder neoplasms%Surgical treatment%Lymph node metastasis
目的 探讨胆囊癌不同手术方式的疗效.方法 回顾性分析2000年1月至2009年10月四川大学华西医院收治的81例胆囊癌患者的临床资料,分析胆囊癌患者采用不同治疗方式的疗效,肿瘤不同浸润深度与淋巴结转移的关系.采用Kaplan-Meier法进行生存分析,生存率比较采用Log-rank法.结果 Ⅰ、Ⅱ、Ⅲ、Ⅳ期胆囊癌患者中位生存时间分别为68、18、7、5个月,1、3、5年生存率分别为100%、80%、60%,57%、29%、14%,27%、7%、0,11%、4%、0.不同TNM分期患者的生存率比较,差异有统计学意义(P＜0.05).本组81例胆囊癌患者中,67例行手术治疗,T1b期患者中,行标准根治术和单纯胆囊切除术的5年生存率分别为100%和0.Ⅱ期患者中,行标准根治术和单纯胆囊切除术的中位生存时间分别为45个月和12个月,1、3、5年生存率分别为67%、33%、33%和50%、0、0,两者比较,差异有统计学意义(P＜0.05).Ⅲ期患者中,行标准根治术的1、3、5年生存率分别为33%、17%、6%,行扩大根治术的生存时间均超过12个月,而行其他治疗方式的生存时间均未超过12个月.Ⅳ期患者中,行扩大根治术和标准根治术的1、3、5年生存率分别为38%、12%、0和14%、0、0,行其他治疗方式的生存时间均未超过12个月.行淋巴结清扫的2例T1期患者均未出现淋巴结转移;15例T2期患者中7例出现淋巴结转移;14例T3期患者中7例出现淋巴结转移,其中1例出现N2站转移;13例T4期患者中12例出现淋巴结转移,其中4例出现N2站转移.结论 肿瘤浸润深度影响淋巴结转移.T1b、Ⅱ、Ⅲ期胆囊癌患者需行胆囊癌根治术.Ⅳ期胆囊癌患者行扩大根治术并发症发生率虽然较高,但与其他治疗方式比较,患者可获得更长的生存时间.
目的 探討膽囊癌不同手術方式的療效.方法 迴顧性分析2000年1月至2009年10月四川大學華西醫院收治的81例膽囊癌患者的臨床資料,分析膽囊癌患者採用不同治療方式的療效,腫瘤不同浸潤深度與淋巴結轉移的關繫.採用Kaplan-Meier法進行生存分析,生存率比較採用Log-rank法.結果 Ⅰ、Ⅱ、Ⅲ、Ⅳ期膽囊癌患者中位生存時間分彆為68、18、7、5箇月,1、3、5年生存率分彆為100%、80%、60%,57%、29%、14%,27%、7%、0,11%、4%、0.不同TNM分期患者的生存率比較,差異有統計學意義(P＜0.05).本組81例膽囊癌患者中,67例行手術治療,T1b期患者中,行標準根治術和單純膽囊切除術的5年生存率分彆為100%和0.Ⅱ期患者中,行標準根治術和單純膽囊切除術的中位生存時間分彆為45箇月和12箇月,1、3、5年生存率分彆為67%、33%、33%和50%、0、0,兩者比較,差異有統計學意義(P＜0.05).Ⅲ期患者中,行標準根治術的1、3、5年生存率分彆為33%、17%、6%,行擴大根治術的生存時間均超過12箇月,而行其他治療方式的生存時間均未超過12箇月.Ⅳ期患者中,行擴大根治術和標準根治術的1、3、5年生存率分彆為38%、12%、0和14%、0、0,行其他治療方式的生存時間均未超過12箇月.行淋巴結清掃的2例T1期患者均未齣現淋巴結轉移;15例T2期患者中7例齣現淋巴結轉移;14例T3期患者中7例齣現淋巴結轉移,其中1例齣現N2站轉移;13例T4期患者中12例齣現淋巴結轉移,其中4例齣現N2站轉移.結論 腫瘤浸潤深度影響淋巴結轉移.T1b、Ⅱ、Ⅲ期膽囊癌患者需行膽囊癌根治術.Ⅳ期膽囊癌患者行擴大根治術併髮癥髮生率雖然較高,但與其他治療方式比較,患者可穫得更長的生存時間.
목적 탐토담낭암불동수술방식적료효.방법 회고성분석2000년1월지2009년10월사천대학화서의원수치적81례담낭암환자적림상자료,분석담낭암환자채용불동치료방식적료효,종류불동침윤심도여림파결전이적관계.채용Kaplan-Meier법진행생존분석,생존솔비교채용Log-rank법.결과 Ⅰ、Ⅱ、Ⅲ、Ⅳ기담낭암환자중위생존시간분별위68、18、7、5개월,1、3、5년생존솔분별위100%、80%、60%,57%、29%、14%,27%、7%、0,11%、4%、0.불동TNM분기환자적생존솔비교,차이유통계학의의(P＜0.05).본조81례담낭암환자중,67례행수술치료,T1b기환자중,행표준근치술화단순담낭절제술적5년생존솔분별위100%화0.Ⅱ기환자중,행표준근치술화단순담낭절제술적중위생존시간분별위45개월화12개월,1、3、5년생존솔분별위67%、33%、33%화50%、0、0,량자비교,차이유통계학의의(P＜0.05).Ⅲ기환자중,행표준근치술적1、3、5년생존솔분별위33%、17%、6%,행확대근치술적생존시간균초과12개월,이행기타치료방식적생존시간균미초과12개월.Ⅳ기환자중,행확대근치술화표준근치술적1、3、5년생존솔분별위38%、12%、0화14%、0、0,행기타치료방식적생존시간균미초과12개월.행림파결청소적2례T1기환자균미출현림파결전이;15례T2기환자중7례출현림파결전이;14례T3기환자중7례출현림파결전이,기중1례출현N2참전이;13례T4기환자중12례출현림파결전이,기중4례출현N2참전이.결론 종류침윤심도영향림파결전이.T1b、Ⅱ、Ⅲ기담낭암환자수행담낭암근치술.Ⅳ기담낭암환자행확대근치술병발증발생솔수연교고,단여기타치료방식비교,환자가획득경장적생존시간.
Objective To investigate the therapeutic effects of different surgical procedures for the treatment of gallbladder cancer. Methods The clinical data of 81 patients with gallbladder cancer who were admitted to the West China Hospital of Sichuan University from January 2000 to October 2009 were retrospectively analyzed.The efficacies of different surgical procedures for the treatment of gallbladder cancer, and the relationship between T stage and lymph node metastasis were investigated. The postoperative survival rates of patients in different TNM stages were analyzed and compared using the Kaplan-Meier method and Log-rank test, respectively. Results The median survival times of patients in stage Ⅰ , Ⅱ ,Ⅲ and Ⅳ were 68, 18, 7 and 5 months, respectively. The 1-,3-, 5-year survival rates were 100%, 80% and 60% for patients in stage Ⅰ, 57%, 29% and 14% for patients in stage Ⅱ, 27%, 7% and 0 for patients in stage Ⅲ and 11%, 4% and 0 for patients in stage Ⅳ. There were significant differences in the survivals of patients in different TNM stages ( P ＜ 0.05 ). Of the 81 patients, 67 received surgical treatment. The 5-year survival rate was 100% for patients in stage T1b who received standard radical resection and 0 for patients who received simple cholecystectomy. The median survival time was 45 months for patients in stage Ⅱ who received standard radical resection and 12 months for patients in stage Ⅱ who received simple cholecystectomy, and their 1-, 3-, 5-year survival rates were 67%, 33%, 33% and 50%, 0, 0, respectively, with significant differences ( P ＜ 0. 05 ). The 1-, 3-, 5-year survival rates of patients in stage Ⅲ who received standard radical resection were 33%, 17% and 6%, respectively. The survival time of patients who received extended radical resection was longer than 12 months, while the survival time of patients who received standard radical resection or other palliative therapy was shorter than 12 months. The 1-, 3-, 5-year survival rates of patients in stage Ⅳ who received extended radical resection and standard radical resection were 38%, 12%, 0and 14%, 0, 0, respectively. The survival time of patients in stage Ⅳ who received other treatments was shorter than 12 months. Lymph node metastasis were identified in 7 patients in stage T2(n = 15), 7 patients in stage T3(n = 14), and 12 patients in stage T4(n = 13), no patient in stage T1 (n =2) was found with lymph node metastasis. Conclusions Lymph node metastasis is significantly influenced by the depth of invasion of the gallbladder cancer. For patients in stage T1b, Ⅱ and Ⅲ, radical resection of gallbladder cancer is necessary; for patients in stage Ⅳ, although the incidence of complication is higher, the survival time is much longer when compared with other treatments.
