CAJ | 학술논문

目的探讨区域淋巴结清扫范围对T2期胆囊癌患者预后的影响.方法回顾性分析1990年1月至2009年12月上海交通大学医学院附属新华医院48例施行胆囊癌根治术的T2期胆囊癌患者的临床资料.根据术中淋巴结清扫范围分为:标准组(23例),行标准区域淋巴结清扫(清扫胆囊管、胆总管周围及肝十二指肠韧带等部位的淋巴结);扩大组(25例),行扩大区域淋巴结清扫(清扫肝十二指肠韧带、胰头周围、十二指肠周围、门静脉周围、肝总动脉旁、腹腔干等部位的淋巴结).总结不同范围淋巴结清扫对T2期胆囊癌患者的治疗效果,采用Fisher确切概率法分析并发症发生率,Kaplan-Meier法进行生存分析,生存率的比较采用Log-rank法.结果两组患者均无围手术期死亡.标准组患者并发症发生率为17%(4/23),扩大组患者并发症发生率为24%(6/25),两组比较,差异无统计学意义(P＞0.05).标准组患者5年累积生存率为40%,中位生存时间为29.8个月;扩大组患者5年累积生存率为66%,中位生存时间为53.2个月,两组比较,差异有统计学意义(x2=4.687,P＜0.05).结论 T2期胆囊癌患者在原发病灶能够根治性切除的基础上,应该行扩大区域淋巴结清扫.
목적 탐토구역림파결청소범위대T2기담낭암환자예후적영향.방법 회고성분석1990년1월지2009년12월상해교통대학의학원부속신화의원48례시행담낭암근치술적T2기담낭암환자적림상자료.근거술중림파결청소범위분위:표준조(23례),행표준구역림파결청소(청소담낭관、담총관주위급간십이지장인대등부위적림파결);확대조(25례),행확대구역림파결청소(청소간십이지장인대、이두주위、십이지장주위、문정맥주위、간총동맥방、복강간등부위적림파결).총결불동범위림파결청소대T2기담낭암환자적치료효과,채용Fisher학절개솔법분석병발증발생솔,Kaplan-Meier법진행생존분석,생존솔적비교채용Log-rank법.결과 량조환자균무위수술기사망.표준조환자병발증발생솔위17%(4/23),확대조환자병발증발생솔위24%(6/25),량조비교,차이무통계학의의(P＞0.05).표준조환자5년루적생존솔위40%,중위생존시간위29.8개월;확대조환자5년루적생존솔위66%,중위생존시간위53.2개월,량조비교,차이유통계학의의(x2=4.687,P＜0.05).결론 T2기담낭암환자재원발병조능구근치성절제적기출상,응해행확대구역림파결청소.
Objective To investigate the efficacy of regional lymphadenectomy for patients with T2 gallbladder cancer. Methods From January 1990 to December 2009, 48 patients with T2 gallbladder cancer received regional lymphadenectomy following radical surgery at the Xinhua Hospital of Shanghai Jiaotong University, and their clinical data were retrospectively analyzed. Patients were divided into two groups according to the range of lymphadenectomy. Standard group (23 patients): lymph nodes in the regions of bile duct, common bile duct and hepatoduodenal ligament were dissected; extended group (25 patients): lymph nodes in the regions of hepatoduodenal ligament, head of pancreas, duodenum, portal vein, common hepatic artery and celiac axis were dissected).The condition of patients in the two groups were compared after the treatment. The morbidity and survival rate were analyzed by using Fisher exact test and Kaplan-Meier method, respectively, and the survival rates between the two groups were compared by using Log-rank test. Results No perioperative death was found in the two groups. The morbidities was 17% (4/23) in the standard group and 24% (6/25) in the extended group, with no significant difference between the two groups ( P ＞ 0.05 ). The 5-year cumulative survival rate and median survival time were 40% and 29.8 months in the standard group, and 66% and 53.2 months in the extended group, with significant differences between the two groups ( x2 = 4. 687, P ＜ 0.05 ). Conclusion Extended regional lymphadenectomy should be performed on patients with T2 gallbladder cancer if the primary lesions can be dissected radically.