不同手术方式治疗中晚期胆囊癌的生存分析

目的:评价不同手术方式对中晚期胆囊癌患者生存的影响.方法:回顾性分析2000年1月-2009年12月接受不同手术方式治疗的72例中晚期胆囊癌患者,包括胆囊癌扩大根治术20例、姑息性切除术13例、单纯胆管内或胆管外引流术25例以及剖腹探查术14例,比较不同手术方式治疗组患者的术后并发症和生存情况.结果:66例患者获得随访,其中胆囊癌扩大根治术19例,姑息性切除术13例,单纯胆管内或胆管外引流术22例,剖腹探查术12例.胆囊癌扩大根治术后的中位生存时间(12个月)明显优于姑息性切除术(4个月)、单纯胆管内或胆管外引流术(2个月)或剖腹探查术(3个月),差异有统计学意义(P＜0.05).胆囊癌扩大根治术后的1年和2年生存率分别为52.6％和26.3％,姑息性切除术后的1年和2年生存率分别为7.7％和0.0％,单纯胆管内或胆管外引流术后的1年和2年生存率分别为4.5％和0.0％,剖腹探查术后的1年和2年生存率均为0.0％.胆囊癌扩大根治术后的1年和2年生存率均明显高于其余3种手术方式(P＜0.05).20例接受胆囊癌扩大根治术的患者中,有6例发生术后并发症.结论:胆囊癌扩大根治术与姑息性切除术、单纯胆管内或胆管外引流术以及剖腹探查术相比,可显著延长患者的术后生存时间.应当考虑在中晚期胆囊癌患者中严格筛选合适病例以实施胆囊癌扩大根治术,并积极预防术后并发症.

Comparison of survival of patients with advanced gallbladder cancer undergoing different surgical procedures

Objective: To evaluate the impact of different surgical procedures on survival of patients with advanced gallbladder cancer. Methods: The clinical records and follow-up information from 72 patients who were diagnosed as having advanced gallbladder carcinoma and underwent different surgical procedures including extended radical resection (n = 20), palliative resection (n = 13), internal or external biliary drainage (n = 25) and exploratory laparotomy (n = 14) between January 2000 and December 2009 were retrospectively reviewed. The postoperative complications and the median survival time as well as one-year and two-year survival rates were compared among patients undergoing different surgical procedures. Results: There were 66 patients who were not lost and 6 patients who were lost to follow-up. The 66 patients who were not lost to follow-up included 19 patients in extended radical resection group, 13 patients in palliative resection group, 22 patients in internal or external biliary drainage group, and 12 patients in exploratory laparotomy group. The median survival time of the extended radical resection group was 12 months, which was significantly higher than those of the palliative resection group (4 months), internal or external biliary drainage group (2 months) and exploratory laparotomy group (3 months) (P < 0.05). The one-year and two-year survival rates of the extended radical resection group were 52.6% and 26.3%, respectively, which were also significantly higher than those of the palliative resection group (7.7% and 0.0%), internal or external biliary drainage group (4.5% and 0.0%) and exploratory laparotomy group (0.0% and 0.0%) (P < 0.05). Postoperative complications were observed in 6 of the 20 patients in the extended radical resection group. Conclusion: Compared with surgical procedures of palliative resection, internal or external biliary drainage and exploratory laparotomy, the extended radical resection can obviously prolong the survival time of the patients with advanced gallbladder cancer. The extended radical resection should be considered after rigorous screening and clinical assessment, and the postoperative complications should be prevented.