目的 探索胆囊癌发生的相关危险因素,为防治胆囊癌提供理论依据.方法 回顾性分析2000年1月至2010年12月北京协和医院收治的153例胆囊癌患者(胆囊癌组)的临床病理资料,并抽取同期收治的300例胆囊结石患者(胆囊结石组)和300例非胆道疾病的成年患者(对照组)作为对照进行1:2病例对照研究.计数资料采用x2检验,对相关危险因素先进行单因素分析,采用x2检验,筛选出有统计学意义的可疑危险因素,再用多因素Logistic回归方程进行分析.结果 胆囊癌组与对照组患者比较,年龄、胆囊结石病史、绝经年龄、累积行经时间、生育与否及生育次数是胆囊癌的危险因素,差异有统计学意义(x2=58.22,180.14,9.59,24.30,18.66,15.17,P＜0.05)；年龄、胆囊结石病史、累积行经时间及生育次数是胆囊癌的独立危险因素(x2=55.76,180.95,24.30,8.54,P＜0.05)；进一步分析发现,有胆囊结石的患者罹患胆囊癌的危险性是无相关病史患者的34倍( OR =34.22).绝经年龄越晚(51～55岁)、累积行经时间越长(≥30年)、生育次数较多(3次)的女性患胆囊癌的可能性越大(OR=3.96,9.68,3.51).胆囊癌组胆囊结石患者与胆囊结石组患者比较,年龄、胆囊结石病程、累积行经时间及生育次数是胆囊癌的危险因素(x2=70.66,16.66,11.59,4.69,P＜0.05);年龄、胆囊结石病程及累积行经时间是患胆囊癌的独立危险因素(x2=64.29,8.82,5.58,P＜0.05)；进一步分析发现,罹患胆囊癌危险性随着年龄升高而增大,胆囊癌发生的危险性随着结石病程延长而升高.对于女性患者,累积行经时间≥30年也会增加罹患胆囊癌的危险因素.结论 年龄、胆囊结石病史、胆囊结石病程、累积行经时间及生育次数可能是胆囊癌发病的危险因素.对于年龄≥60岁、胆囊结石病程≥3年的患者应切除胆囊,以降低胆囊癌的发病率；女性患者有以上表现者应高度重视,及时诊断和治疗.
目的 探索膽囊癌髮生的相關危險因素,為防治膽囊癌提供理論依據.方法 迴顧性分析2000年1月至2010年12月北京協和醫院收治的153例膽囊癌患者(膽囊癌組)的臨床病理資料,併抽取同期收治的300例膽囊結石患者(膽囊結石組)和300例非膽道疾病的成年患者(對照組)作為對照進行1:2病例對照研究.計數資料採用x2檢驗,對相關危險因素先進行單因素分析,採用x2檢驗,篩選齣有統計學意義的可疑危險因素,再用多因素Logistic迴歸方程進行分析.結果 膽囊癌組與對照組患者比較,年齡、膽囊結石病史、絕經年齡、纍積行經時間、生育與否及生育次數是膽囊癌的危險因素,差異有統計學意義(x2=58.22,180.14,9.59,24.30,18.66,15.17,P＜0.05)；年齡、膽囊結石病史、纍積行經時間及生育次數是膽囊癌的獨立危險因素(x2=55.76,180.95,24.30,8.54,P＜0.05)；進一步分析髮現,有膽囊結石的患者罹患膽囊癌的危險性是無相關病史患者的34倍( OR =34.22).絕經年齡越晚(51～55歲)、纍積行經時間越長(≥30年)、生育次數較多(3次)的女性患膽囊癌的可能性越大(OR=3.96,9.68,3.51).膽囊癌組膽囊結石患者與膽囊結石組患者比較,年齡、膽囊結石病程、纍積行經時間及生育次數是膽囊癌的危險因素(x2=70.66,16.66,11.59,4.69,P＜0.05);年齡、膽囊結石病程及纍積行經時間是患膽囊癌的獨立危險因素(x2=64.29,8.82,5.58,P＜0.05)；進一步分析髮現,罹患膽囊癌危險性隨著年齡升高而增大,膽囊癌髮生的危險性隨著結石病程延長而升高.對于女性患者,纍積行經時間≥30年也會增加罹患膽囊癌的危險因素.結論 年齡、膽囊結石病史、膽囊結石病程、纍積行經時間及生育次數可能是膽囊癌髮病的危險因素.對于年齡≥60歲、膽囊結石病程≥3年的患者應切除膽囊,以降低膽囊癌的髮病率；女性患者有以上錶現者應高度重視,及時診斷和治療.
목적 탐색담낭암발생적상관위험인소,위방치담낭암제공이론의거.방법 회고성분석2000년1월지2010년12월북경협화의원수치적153례담낭암환자(담낭암조)적림상병리자료,병추취동기수치적300례담낭결석환자(담낭결석조)화300례비담도질병적성년환자(대조조)작위대조진행1:2병례대조연구.계수자료채용x2검험,대상관위험인소선진행단인소분석,채용x2검험,사선출유통계학의의적가의위험인소,재용다인소Logistic회귀방정진행분석.결과 담낭암조여대조조환자비교,년령、담낭결석병사、절경년령、루적행경시간、생육여부급생육차수시담낭암적위험인소,차이유통계학의의(x2=58.22,180.14,9.59,24.30,18.66,15.17,P＜0.05)；년령、담낭결석병사、루적행경시간급생육차수시담낭암적독립위험인소(x2=55.76,180.95,24.30,8.54,P＜0.05)；진일보분석발현,유담낭결석적환자리환담낭암적위험성시무상관병사환자적34배( OR =34.22).절경년령월만(51～55세)、루적행경시간월장(≥30년)、생육차수교다(3차)적녀성환담낭암적가능성월대(OR=3.96,9.68,3.51).담낭암조담낭결석환자여담낭결석조환자비교,년령、담낭결석병정、루적행경시간급생육차수시담낭암적위험인소(x2=70.66,16.66,11.59,4.69,P＜0.05);년령、담낭결석병정급루적행경시간시환담낭암적독립위험인소(x2=64.29,8.82,5.58,P＜0.05)；진일보분석발현,리환담낭암위험성수착년령승고이증대,담낭암발생적위험성수착결석병정연장이승고.대우녀성환자,루적행경시간≥30년야회증가리환담낭암적위험인소.결론 년령、담낭결석병사、담낭결석병정、루적행경시간급생육차수가능시담낭암발병적위험인소.대우년령≥60세、담낭결석병정≥3년적환자응절제담낭,이강저담낭암적발병솔；녀성환자유이상표현자응고도중시,급시진단화치료.
Objective To investigate the risk factors of gallbladder carcinoma,so as to provide theoretical base for the prevention of gallbladder carcinoma.Methods The clinical data of 153 patients with gallbladder carcinoma (gallbladder carcinoma group) who were admitted to the Peking Union Medical College Hospital from January 2000 to December 2010 were retrospectively analyzed. A total of 300 patients with cholecystolithiasis (cholecystolithiasis group) and 300 patients without gallbladder carcinoma or cholecystolithiasis (control group)were collected and matched at the ratio of 1∶2 to conduct the controlled study.Data were statistically analyzed by the Chi-square test and conditional Logistric regression.Results Univariate analysis showed significant difference in age,history of cholecystolithiasis,postmenopausal age,accumulated menstrual period,giving birth or not and number of birth between gallbladder carcinoma group and control group ( x2 =58.22,180.14,9.59,24.30,18.66,15.17,P ＜0.05).Age,history of cholecystolithiasis,accumulated menstrual period and number of birth were the independent risk factors of gallbladder carcinoma (x2 =55.76,180.95,24.30,8.54,P ＜ 0.05).The risk of having gallbladder carcinoma in patients who had a history of cholecystolithiasis was 34 times higher than those who did not have the history of cholecystolithiasis (OR =34.22).Late postmenopausal age (51 -55 years old),longer accumulated menstrual period ( ≥30 years),and the number of birth ( 3 times) were associated with higher risk of gallbladder carcinoma (OR =3.96,9.68,3.51 ). Age,course of cholecystolithiasis and accumulated menstrual period and number of birth were the risk factors of gallbladder carcinoma when comparing patients who have history of cholecystolithiasis in the gallbladder carcinoma group with those in the cholecystolithiasis group (x2 =70.66,16.66,11.59,4.69,P ＜ 0.05 ).Age,course of cholecystolithiasis and accumulated menstrual period were the independent risk factors of gallbladder carcinoma ( x2 =64.29,8.82,5.58,P ＜ 0.05).The risk of gallbladder carcinoma increased as the increase of age and course of cholecystolithiasis. The accumulated menstrual period ≥ 30 years was also a risk factor of gallbladder carcinoma. Conclusions Age,history of cholecystolithiasis,course of cholecystolithiasis,accumulated menstrual period and number of birth may be the risk factors of gallbladder carcinoma.For patients with age above 60 years and course of cholecystolithiasis above 3 years,cholecystectomy should be conducted to reduce the incidence of gallbladder carcinoma,and great importance should be attached to female patients with indications mentioned above.
