中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2012年
7期
557-559
,共3页
张云利%郭剑民%王新保%杨立涛%周立新%杜义安%王兵
張雲利%郭劍民%王新保%楊立濤%週立新%杜義安%王兵
장운리%곽검민%왕신보%양립도%주립신%두의안%왕병
胆囊肿瘤%再手术%病理学%临床%预后
膽囊腫瘤%再手術%病理學%臨床%預後
담낭종류%재수술%병이학%림상%예후
Gallbladder neoplasms%Reoperation%Pathology%clinical%Prognosis
目的 探讨意外胆囊癌再手术的治疗效果.方法 对2000-2010年45例胆囊切除术后发现的意外胆囊癌再手术治疗的临床资料进行回顾性总结.生存分析采Kaplan-Meier法,logrank检验差异显著性,计数资料采用x2检验,P＜0.05为差异有统计学意义.结果 45例意外胆囊癌(pT2 33例,pT3 12例)40例再次行根治性胆囊床肝楔形切除加淋巴结清扫,5例行姑息性手术.术后发现淋巴结转移10例(pT24例,pT36例),肝转移3例(pT2 1例,pT32例),同时合并腹腔种植(pT3)及广泛转移(PT2)各1例.5例行姑息性手术者生存时间3～8个月,40例根治性术后生存期明显延长(40.4±2.7)个月.胆囊切除术后4周内进行再手术,术后生存时间[(37.1±2.2)个月]明显长于4周后再手术的患者[(22.4±5.8)个月].结论 胆囊切除术后发现意外胆囊癌(pT2/pT3)需及时剖腹行根治性手术,可改善患者的预后和延长生存时间.
目的 探討意外膽囊癌再手術的治療效果.方法 對2000-2010年45例膽囊切除術後髮現的意外膽囊癌再手術治療的臨床資料進行迴顧性總結.生存分析採Kaplan-Meier法,logrank檢驗差異顯著性,計數資料採用x2檢驗,P＜0.05為差異有統計學意義.結果 45例意外膽囊癌(pT2 33例,pT3 12例)40例再次行根治性膽囊床肝楔形切除加淋巴結清掃,5例行姑息性手術.術後髮現淋巴結轉移10例(pT24例,pT36例),肝轉移3例(pT2 1例,pT32例),同時閤併腹腔種植(pT3)及廣汎轉移(PT2)各1例.5例行姑息性手術者生存時間3～8箇月,40例根治性術後生存期明顯延長(40.4±2.7)箇月.膽囊切除術後4週內進行再手術,術後生存時間[(37.1±2.2)箇月]明顯長于4週後再手術的患者[(22.4±5.8)箇月].結論 膽囊切除術後髮現意外膽囊癌(pT2/pT3)需及時剖腹行根治性手術,可改善患者的預後和延長生存時間.
목적 탐토의외담낭암재수술적치료효과.방법 대2000-2010년45례담낭절제술후발현적의외담낭암재수술치료적림상자료진행회고성총결.생존분석채Kaplan-Meier법,logrank검험차이현저성,계수자료채용x2검험,P＜0.05위차이유통계학의의.결과 45례의외담낭암(pT2 33례,pT3 12례)40례재차행근치성담낭상간설형절제가림파결청소,5례행고식성수술.술후발현림파결전이10례(pT24례,pT36례),간전이3례(pT2 1례,pT32례),동시합병복강충식(pT3)급엄범전이(PT2)각1례.5례행고식성수술자생존시간3～8개월,40례근치성술후생존기명현연장(40.4±2.7)개월.담낭절제술후4주내진행재수술,술후생존시간[(37.1±2.2)개월]명현장우4주후재수술적환자[(22.4±5.8)개월].결론 담낭절제술후발현의외담낭암(pT2/pT3)수급시부복행근치성수술,가개선환자적예후화연장생존시간.
Objective To investigate the effect of the second resection for unsuspected gallbladder carcinoma discovered after cholecystectomy.Methods A retrospective clincopathological analysis was conducted for 45 cases of unsuspected gallbladder carcinoma receiving second operation at our hospital from January 2000 to December 2010.Result Of the 45 cases with unsuspected gallbladder carcinoma (33 pT2,12 pT3 ),40 cases received second radical reeection of the liver bed with lymph dissection; the remaining 5 cases received palliative operation.Amongst 45 patients lymph metastasis (4 pT2,6 pT3 ) was found in 10 cases,liver metastasis ( 2 pT2,1 pT3 ) in 3,parietal seeding in 1 ( pT3 ) and distant metastasis ( pT2 ) in one.The 5 patients receiving palliative operation died in 3 ～ 8 months and 40 patients receiving the radical operation achieved long-term survival ( 40.4 ± 2.7 months) after the operation.The effect of second operation which was done within 4 weeks after the first cholecystectomy was better than that of the operation done beyond 4 weeks ( survival time 37.1 ± 2.2 vs 22.4 ± 5.8months).Conclusions Radical resection for unsuspected gallbladder carcinoma discovered after the initial cholecystectomy helps improve prognosis and prolong patients survival time.
