CAJ | 학술논문

目的：探讨胆囊癌根治术与介入栓塞化疗治疗晚期胆囊癌的临床效果。方法回顾性分析襄阳市中心医院2009年4月至2012年5月收治的66例胆囊癌晚期患者，根据治疗方式分为手术组38例和栓塞组28例，手术组采用胆囊癌根治术，栓塞组采用Seldingers法经股动脉进行栓塞治疗，比较两组患者的近期疗效及两年预后情况。结果手术组患者全部经手术切除，未发生术中及住院期间死亡，术后肝功能正常，黄疸逐渐消退。栓塞组患者治疗3个月后CR 0例，PR 10例，SD 14例，PD 4例。总有效率85.71%(24/28)。手术组的无进展生存中位时间为9个月，明显长于栓塞组的6个月(χ2=4.563，P=0.037)；手术组的两年生存率为39.47%(15/38)，手术组有1例患者失访；栓塞组的两年生存率为32.14%(9/28)，两组的两年生存率比较差异无统计学意义(χ2=0.483，P=0.487)。手术组的中位生存时间为20个月，栓塞组为14个月，两组中位生存时间比较差异有统计学意义(χ2=4.034，P=0.044)。手术组的术后并发症发生率为13.16%，栓塞组治疗过程中的并发症发生率为46.43%，手术组显著低于栓塞组(χ2=8.396，P=0.004)。结论晚期胆囊癌患者采用手术根治法对延长患者的生存时间有帮助，同时术后并发症率较栓塞治疗低。
목적：탐토담낭암근치술여개입전새화료치료만기담낭암적림상효과。방법회고성분석양양시중심의원2009년4월지2012년5월수치적66례담낭암만기환자，근거치료방식분위수술조38례화전새조28례，수술조채용담낭암근치술，전새조채용Seldingers법경고동맥진행전새치료，비교량조환자적근기료효급량년예후정황。결과수술조환자전부경수술절제，미발생술중급주원기간사망，술후간공능정상，황달축점소퇴。전새조환자치료3개월후CR 0례，PR 10례，SD 14례，PD 4례。총유효솔85.71%(24/28)。수술조적무진전생존중위시간위9개월，명현장우전새조적6개월(χ2=4.563，P=0.037)；수술조적량년생존솔위39.47%(15/38)，수술조유1례환자실방；전새조적량년생존솔위32.14%(9/28)，량조적량년생존솔비교차이무통계학의의(χ2=0.483，P=0.487)。수술조적중위생존시간위20개월，전새조위14개월，량조중위생존시간비교차이유통계학의의(χ2=4.034，P=0.044)。수술조적술후병발증발생솔위13.16%，전새조치료과정중적병발증발생솔위46.43%，수술조현저저우전새조(χ2=8.396，P=0.004)。결론만기담낭암환자채용수술근치법대연장환자적생존시간유방조，동시술후병발증솔교전새치료저。
Objective To compare the clinical effect of radical cholecystectomy with interventional chemo-embolization in the treatment of advanced gallbladder carcinoma. Methods Sixty-six patients of advanced gallblad-der carcinoma in our hospital from April 2009 to May 2012 were divided into the surgery group (38 cases) and emboli-zation group (28 cases) according to treatment, which were treated with radical cholecystectomy and interventional chemoembolization by Seldingers method via femoral artery, respectively. The short-term clinical efficacy and 2-year prognosis were compared between the two groups. Results In the surgery group, the tumors were all removed, with no intraoperative and hospitalization death occurred. After surgery, the liver function returned normal and jaundice fad-ed. Three months after treatment, there were 0 case of complete response (CR), 10 cases of partial response (PR), 14 cases of stable disease (SD), and 4 cases of progressive disease (PD) in embolization group, with the total effective rate of 85.71%(24/28). The median progression-free survival of surgery group was 9 months, longer of 6 months of embolization group (χ2=4.563, P=0.037). The 2-year survival rate was 39.47%(15/38) in surgery group, with 1 patient lost during follow-up. The 2-year survival rate of embolization group was 32.14%(9/28), showing no statistically sig-nificant difference with those of surgery group (χ2=0.483, P=0.487). The median survival time was 20 months in sur-gery group and 14 months in embolization group, with statistically significant difference between the two groups (χ2=4.034, P=0.044). The incidence of postoperative complications was 13.16%in surgery group and 46.43%in emboliza-tion group, with statistically significant difference between the two groups (χ2=8.396, P=0.004). Conclusion Radical cholecystectomy helps prolong the survival time of patients with advanced gallbladder carcinoma, and, at the same time, lower the rate of postoperative complications, compared with interventional chemoembolization.