59例胆囊癌病理分期、手术方式与预后分析

目的：探讨胆囊癌病理分期、手术方法与预后的关系。方法：回顾性分析2002年1月至2012年12月我院59例行手术治疗的胆囊癌患者的临床资料，其中Nevin分期Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ期分别为2、12、22、12、11例；采用Kaplan-Meier法和Log-Rank法对其病理分期、手术方法与预后的关系进行统计分析。结果：59例中48例获随访，随访时间0．5～126个月，平均20．4个月。48例手术治疗的胆囊癌患者总体中位生存时间35．6个月。Ⅰ＋Ⅱ期、Ⅲ＋Ⅳ期、Ⅴ期胆囊癌患者中位生存时间分别为92．4个月、16．9个月和3．5个月，Ⅰ＋Ⅱ期、Ⅲ＋Ⅳ期胆囊癌患者生存率均高于Ⅴ期患者（P＜0．05），Ⅰ＋Ⅱ期胆囊癌患者生存率高于Ⅲ＋Ⅳ期患者（P＜0．05）。单纯胆囊切除组、根治性手术组、姑息性手术组患者的中位生存时间分别为45．8个月、45．8个月和3．6个月，单纯胆囊切除组、根治性手术组患者生存率均高于姑息性手术组患者（P＜0．05），而单纯胆囊切除组与根治性手术组患者生存率差别无统计学意义（ P＞0．05）。结论：胆囊癌患者Nevin分期越早，预后越好。依据病理分期选择相应的术式，单纯胆囊切除与根治性切除患者术后均可获得长期生存。单纯胆囊切除、根治性切除患者预后优于姑息性手术患者。

Pathological Stage, Surgical Methods and Prognosis of 59 Patients with Gallbladder Carcinoma

Objective：To explore the pathological stage , surgical methods and prognosis of gallbladder carci-noma.Methods：Retrospective study was used to analyze the clinical data of 59 postoperative patients with primary carcinoma of gallbladder from January 2002 to December 2012.According Nevin stage,the cases of stage Ⅰ,Ⅱ,Ⅲ,Ⅳ,Ⅴwere 2,12,22,12,11.Kaplan-Meier method and the Log-Rank France are used for the relation between its staging, surgical methods and prognosis .Results：48 cases were followed up for 0.5 to 126 months of 59 cases.The average follow-up time was 20.4 months.48 cases of surgical treatment of gallbladder cancer overall median survival time of 35.6 months.The median survival time （months） of stages Ⅰ＋Ⅱ, Ⅲ＋Ⅳ, Ⅴ carcinoma of gallbladder were：92.4,16.9,3.5.StagesⅠ＋ⅡandⅢ＋Ⅳhad a higher survival rate than stage Ⅴcarcinoma of gallbladder . StagesⅠ＋Ⅱhad a higher survival rate than stages Ⅲ＋Ⅳcarcinoma of gallbladder （P0.05）.Conclusions：Carcinoma of gallbladder with the earlier Nevin sta-ges has the better prognosis .If we select the appropriate basis for staging procedure , both simple cholecystectomy and radical resection patients can have a long -term survival .Patients with simple cholecystectomy and radical resection have the better prognosis than patients with palliative surgery .