临床病理因素和手术方法对胆囊癌预后的影响
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卞建民

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The influence of clinicopathologic factors and operative method on the prognosis of gallbladder carcinoma
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    摘要:

    目的:分析与胆囊癌预后有关的临床病理因素。
    方法:回顾性分析2001—2006年61例进展期胆囊癌外科治疗资料。
    结果:按第6版UICC/AJCC的胆囊癌临床分期标准,IB期8例,IIA期22例,IIB期11例,III期14例,IV期6例。姑息性胆囊切除和/或胆道引流术26例; 胆囊切除、局部淋巴结清扫14例,保留肝外胆管的根治性切除7例,联合肝外胆管切除的根治术13例; 肝胆胰脏器联合切除1例。37例中有18例淋巴结阳性。52例术后得到随访。满6个月生存为41例(67.2%); 满1年生存26例(42.6%); 存活2年以上者10例(16.4%); 3年以上存活7例(11.5%); 1例存活5年以上(1.6%)。术后2年内死亡的51例中,31例随访到死亡前症候:21例有进行性黄疸; 14例有肝脏内多个转移; 12例有顽固性腹水。非明确胆道病原因死亡者5例。
    结论:临床分期和手术方式与胆囊癌患者的预后有关。

    Abstract:

    Objective:To analyze the clinicopathologic factors related to the prognosis of gallbladder carcinoma.
    Methods :A retrospective analysis was conducted on 61 cases of advanced gallbladder carcinoma who were operated on from 2001 to 2006 in Nanjing First Hospital.
    Results:According to the 6th UICC/AJCC TNM classification and staging of gallbladder carcinoma, of the 61 patients, 8 patients were stage IB, 22 were IIA, 11 were IIB, 14 were III and 6 were IV. Palliative cholecystectomy and/or bile duct drainage procedures were performed in 24 patients; removal of gallbladder plus regional lymph nodes and fatty tissue dissections were performed in 14 cases; radical resection was performed in 7 patients; removal of gallbladder and part of liver in combination with resection of bile duct (radical operatian) was performed in 13 patients; 1 patient had extensive radical operation including pancreaticoduodenectomy. In 37 patients, 18 had positive lymph node metastasis. Fifty-two patients were followed up, 41(67.2%) patients were alive at 6 months after operation, 26(42.6%)were alive at 12 months, 10(16.4%) were alive at 24 months, and 7 cases were alive at 36 months, 1 patient is still alive 5 years after operation; 51 patients died within 2 years after operation. The symptoms of recurrence in 31 patients included progressing jaundice (21 cases), metastasis in liver (14 cases), and refractory ascites (12 cases). Five patients died of non- bile duct disease.
    Conclusions:The prognosis of gallbladder cancer has a close relationship with the clinical stage and method of resection.

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卞建民, 吴向阳.临床病理因素和手术方法对胆囊癌预后的影响[J].中国普通外科杂志,2009,18(2):14-.
DOI:10.7659/j. issn.1005-6947.2009.02.014

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  • 在线发布日期: 2009-02-25