手术方式与T2期胆囊癌预后的关系

目的探讨手术方式与肿瘤侵犯胆囊壁全层但未穿透浆膜的他期胆囊癌预后的关系。方法回顾性分析1990-2004年收治的24例佗期胆囊癌的临床资料，采用Kaplan-Meier法分析胆囊癌根治组（14例）和单纯胆囊切除组（10例）的生存率和无瘤生存率。结果根治组和单纯胆囊切除组术后的1、3、5年生存率分别为100％、71％、54％和70％、30％、20％，两组生存时间的差异有统计学意义（x^2=4．659，P=0．031）。根治组和单纯胆囊切除组的中位临床无瘤生存时间分别为45和13．5个月，两组临床无瘤生存时间的差异有统计学意义（x^2=3．854，P=0．049）。结论对佗期胆囊癌应积极行胆囊癌根治手术，胆囊癌根治术是提高佗期胆囊癌长期生存率及临床无瘤生存率的有效手段。     

腹腔镜胆囊切除治疗意外胆囊癌与胆囊癌根治术的临床分析

目的 探讨腹腔镜胆囊切除术(LC)治疗意外胆囊癌与再次行胆囊癌根治术对预后的影响.方法 7例LC术意外胆囊癌(T2期)患者再次接受胆囊癌根治术(开腹或腔镜下),与同期进行的开腹一期根治手术的14例胆囊癌(T2期)患者加以对比,采用Kaplan-Meier法分析两组的生存率. 结果 LC组和开腹组术后的1、3、5年生存率分别为100%、67%、67%和92%、84%、60%,两组生存时间的差异无统计学意义(χ2=0.015,P=0.901).3例浸润深度为胆囊黏膜层的T1a期胆囊癌经LC治疗后均生存6年以上.3例腹腔镜胆囊癌根治术的患者术后随访6～12个月,均为无瘤生存.结论在注意避免术中胆汁溢出、应用标本取出袋等无瘤保护措施得当的情况下,及时行胆囊癌根治术,先期的LC不影响T2期胆囊癌的预后,而对于T1a期胆囊癌仅行LC即可获得满意的长期生存.     

胆囊癌50例诊治体会

目的 探讨胆囊癌的诊断、手术治疗及预后.方法 对2002年7月至2012年7月收治的50例胆囊癌的临床资料进行回顾性分析.结果 经术中或术后病检确诊.按美国癌症联合委员会(AJCC)分期,0期、Ⅰa期6例,经单纯胆囊切除后均生存超过5年;2例Ⅰb期患者行单纯胆囊切除,1年内生存者1例,5年内2例均死亡;3例Ⅰb期患者行根治术,2例生存5年以上;12例Ⅱ期患者行根治术,术后5年生存率为 50.0%;8例Ⅲa期患者行根治术,5年生存率为 37.5%,其中 50.0% 于3年内死亡;Ⅲb期、Ⅳ期共19例,其中16例于1年内死亡.结论 为提高胆囊癌生存率及患者生活质量,AJCC 0期、Ⅰa期行单纯胆囊切除即可.Ⅰb期、Ⅱ期、Ⅲ期需根据患者情况行根治术及扩大根治术,Ⅳ期应仅行提高患者生存质量的姑息性手术或其他治疗.     

腹腔镜胆囊切除术术中或术后发现意外胆囊癌的外科治疗

目的 探讨腹腔镜胆囊切除术(LC)术中或术后发现意外胆囊癌(IGBC)的外科治疗方法及预后影响因素.方法 回顾性分析2002年1月至2013年12月解放军总医院肝胆外科医院收治的83例LC术中或术后发现的IGBC患者的临床病理特点、外科治疗方法及预后,占同期LC总例数的0.82％ (83/10 080).其中男性26例,女性57例,年龄34 ～ 83岁,中位年龄61岁.治疗方式包括单纯LC治疗47例,中转开腹胆囊癌根治术18例,二期胆囊癌根治术16例,二期开腹探查及活检术2例.采用Kaplan-Meier法计算随访病例的累积生存率,Log-rank法比较生存率曲线,Cox回归模型分析各影响因素与生存期的关系.结果 术中快速冰冻切片证实IGBC 35例,术后常规病理确诊48例.按不同手术方式分为4组:单纯LC组(n=47),中转开腹胆囊癌根治术组(n=18),二期胆囊癌根治术组(n=16),二期剖腹探查及活检术组(n=2);各组患者的5年累积生存率分别为89.4％、38.9％、87.5％、0.病理T分期中T1a期、T1b期、T2期、T3期IGBC患者的5年累积生存率分别为95.7％(22/23)、90.0％(18/20)、75.0％ (15/20)、40.0％(8/20),各组生存率差异有统计学意义(P＜0.05).全组患者中位生存期为26个月.Cox回归多因素分析结果显示,病理T分期、有无淋巴结转移、手术中胆囊破裂是影响IGBC患者预后的独立危险因素(P＜0.05).结论 单纯LC适合治疗T1a期IGBC,若术中有胆囊破裂及胆汁漏出,可行中转开腹胆囊癌根治术;对于可能R0切除的T1b～ T3期IGBC应行标准胆囊癌根治术或扩大根治术.术中注意无瘤操作、仔细剖检胆囊标本、早期发现和早期诊断是提高IGBC外科治疗效果的关键.     

Misdiagnosis and response measures of gallbladder carcinoma

目的 探讨胆囊癌的误、漏诊原因及应对措施.方法 对在2000年1月至2006年7月间我院胆囊切除术中或术后发现的12例胆囊癌的临床资料进行回顾性分析.结果 本组T1期2例、T2期1例行单纯胆囊切除术;T2期5例,T3期3例再次手术行胆囊癌根治术;T4期1例行姑息性手术.T1期2例至今已健康存活7年和8年;T2期有3例分别于术后12、39、78个月死亡;T3期3例分别于术后5、12、16个月死亡;T4期1例于术后3个月死亡.5年存活率T1期为100％,T2期为66.6％,T3、T4期为0.结论 胆囊癌病人的存活率与肿瘤分期相关.原位癌(Tis)、T1期胆囊癌行单纯胆囊切除术即可,对T1期以上的胆囊癌应尽量行开腹胆囊癌根治术.     

何为T1期胆囊癌手术切除的适宜范围

胆囊癌是常见的胆道恶性肿瘤之一，早期胆囊癌定义为局限于粘膜（T1a）或肌层（T1b）的胆囊癌。对于T1a期胆囊癌，单纯的胆囊切除术已足够；然而对于T1b期胆囊癌，是采用单纯胆囊切除术还是实施根治性切除，目前仍存在争议。因此作者对1995年1月～2007年2月韩国Samsung医疗中心290例胆囊癌手术病例进行研究，并对52例病理分期为T1期的病例资料进行了回顾性分析，其中T1a期27例（52％）、T1b期25例（48％），分析内容包括临床病理学特征、手术切除范围和存活率。     

胆囊癌临床分期及手术方式与预后的关系

目的 评价胆囊癌Nevin分期、手术方式与预后的关系.方法 1992年10月至2002年12月间,新华医院手术治疗的82例胆囊癌患者,记录Nevin分期、手术方式及术后生存情况.结果 在行根治术或扩大根治术的47例中淋巴结阳性者38例(80.85%).其中包括3例Ⅱ期、30例Ⅳ期、5例Ⅴ期.侵犯胆囊壁全层的胆囊癌(Ⅲ期+Ⅳ期)中淋巴结转移率为83.3%(30/36).4例行单纯胆囊切除的Ⅰ期患者长期生存.而行单纯胆囊切除的4例Ⅱ期患者及1例Ⅲ期患者存活均未超过3年.行胆囊癌根治术的4例Ⅱ期、1例Ⅲ期及行胆囊癌扩大根治术3例Ⅳ期患者生存5年以上.行扩大根治术的Ⅴ期及剖腹探查病例3年、5年生存率为0.结论 胆囊癌的分期、手术方式与术后生存率有显著关系,Ⅰ期可行单纯胆囊切除,Ⅱ、Ⅲ期胆囊癌应行根治切除手术,Ⅳ期胆囊癌应行扩大根治手术,Ⅴ期患者行扩大根治手术无效.     

腹腔镜胆囊切除术意外胆囊癌58例诊治分析

[摘 要] 目的 探讨腹腔镜胆囊切除术（LC）意外胆囊癌的诊断与治疗。方法 回顾性分析2007 年5 月至2017 年5 月武警安徽省总队医院收治的意外胆囊癌患者58 例临床资料。结果 LC术中发现24 例,术后发现34例;TNM分期T1b 12例,T2 34例,T3 6例,T4 6例。24例术中快速冰冻病理检查证实为胆囊癌,其中22例中转开腹行胆囊癌根治术;34例术后病理证实,其中24例行二次开腹手术。非根治组：12例,仅行单纯胆囊切除术,术后1、2、3年累积生存率分别为65.0%、42.5%、18.0%。根治组：46例,行胆囊癌根治术,术后1、2、3年累积生存率分别为82.5%、62.5%、45.7%,两组生存曲线比较差异有统计学意义（P＜0.05）。结论 胆囊癌患者预后与手术方式、临床分期密切相关,对存在胆囊癌高危因素的患者,建议尽早行胆囊切除术。意外胆囊癌多为早期胆囊癌,应重视术中检查及病理检查,T1b～T3 期宜行根治手术,晚期患者应根据病情行姑息手术。     

意外胆囊癌的临床处理对策与预后

目的探讨意外胆囊癌的临床处理对策与预后。方法回顾性分析意外胆囊癌51例,对其治疗与预后进行统计分析。生存分析采用Kaplan-Meier法,组间比较采用Log-rank检验,多因素分析采用Cox比例风险模型。结果多因素分析表明肿瘤位置、Nevin分期及手术方式是影响预后的独立因素;对于Ⅱ期体底部胆囊癌和Ⅲ、Ⅳ期体底部胆囊癌以及颈部胆囊癌,胆囊癌根治术组优于单纯胆囊切除术组,其差异有统计学意义(P值分别为0.014、0.001及0.018);对于Ⅰ期体底部胆囊癌,单纯胆囊切除术组与胆囊癌根治术组病人的生存率差异无统计学意义(P=0.312)。结论对于NevinⅠ期体底部胆囊癌病人,单纯胆囊切除术已达到根治效果;对于NevinⅠ期颈部胆囊癌及NevinⅡ期以晚的胆囊癌,胆囊癌根治术能有效改善其预后。     

意外胆囊癌的临床处理与预后分析

目的 总结意外胆囊癌的临床病理特点、诊断与治疗方案的选择,分析与预后有关的因素,指导意外胆囊癌的规范化治疗.方法 回顾性分析北京协和医院1999年1月至2009年10月收住院治疗的27例意外胆囊癌的临床资料,应用Kaplan-Meier法对比单纯胆囊切除术组、胆囊癌根治术组以及NevinⅠ、Ⅱ期与Ⅲ、Ⅳ、Ⅴ期患者的累积生存率,对意外胆囊癌的治疗方法与预后进行分析.结果 27例患者以胆囊良性疾病的术前诊断行胆囊切除术,术前诊断以急慢性胆囊炎、胆囊结石和胆囊息肉为主.术后病理学检查证实为胆囊癌,其中低分化腺癌9例,中分化腺癌9例,高分化腺癌4例,腺瘤癌变5例.按Nevin分期,Ⅰ期2例,Ⅱ期5例,Ⅲ期8例,Ⅳ期5例,Ⅴ期7例.胆囊癌根治术组患者累积生存率好于单纯胆囊切除术组(x2=4.450,P=0.035);Nevin Ⅰ、Ⅱ期患者预后显著优于Ⅲ、Ⅳ、Ⅴ期(x2=6.825,P=0.014).结论 意外胆囊癌临床表现缺乏特异性,容易导致误诊,术中快速病理切片检查是明确诊断的重要方法,确诊后首选根治性切除术.     

胆囊癌不同手术方式的疗效分析

目的 探讨胆囊癌不同手术方式的疗效.方法 回顾性分析2000年1月至2009年10月四川大学华西医院收治的81例胆囊癌患者的临床资料,分析胆囊癌患者采用不同治疗方式的疗效,肿瘤不同浸润深度与淋巴结转移的关系.采用Kaplan-Meier法进行生存分析,生存率比较采用Log-rank法.结果 Ⅰ、Ⅱ、Ⅲ、Ⅳ期胆囊癌患者中...     

胆囊癌的综合治疗

Gallbladder cancer is the most common malignancy of biliary tract with a very poor prognosis. The therapeutic strategy of gallbladder cancer has been improved in some aspects. Identifying the accurate stage is the basis of surgical treatment. Radical resection is the only choice of treatment which provides patients long survival. For most patients in T1a stage, simple cholecystectomy is adequate, but dissection of hepatoduodenal ligament should be added when the lesions located in neck and duct of gallbladder. Patients in T1b stage often need radical cholecystectomy. Radical cholecystectomy with Ⅳb and Ⅴ segmentectomy and lymphadenectomy of N2 nodes should be performed to patients in T2 stage. Extended right lobe resection can improve the prognosis of selected T3 and T4 patients.The effect of chemotherapy for gallbladder cancer remains unsatisfactory, and current chemotherapeutic regimens were based on 5-FU, gemcitabine or S-1. The effect of a new chemotherapeutic sensitization scheme with continuous infusion of somatostatin,epirubicin 5-FU/CF and cisplatin is under research, and the preliminary results are promising. Radiation shows some benefits to patients with gallbladder cancer, but its effects are still uncertain.     

Early gallbladder carcinoma does not warrant radical resection

BACKGROUND: This study was designed to address whether gallbladder cancer invading the muscle layer (stage pT(1b)) is a local disease and whether radical resection is necessary. METHODS: A retrospective analysis of 25 patients with pT(1b) gallbladder tumours, 13 of whom underwent simple cholecystectomy and 12 radical resection with regional lymph node dissection, was performed. A total of 147 regional lymph nodes was examined for metastasis. The median follow-up time was 95 months. RESULTS: No patient had blood vessel or perineural invasion on histology. Lymphatic vessel invasion was seen in one patient. Both overt metastasis and micrometastases were absent in all lymph nodes examined. Overall 10-year survival was 87 per cent. The outcome after simple cholecystectomy was comparable to that after radical resection (P = 0.16). Two patients who underwent radical resection died from tumour relapse in distant sites. CONCLUSION: Most pT(1b) gallbladder carcinomas spread only locally. Additional radical resection is not necessary when the depth of invasion of gallbladder carcinoma is limited to the muscle layer after simple cholecystectomy.     

Surgical treatment of patients with T2 gallbladder carcinoma invading the subserosal layer

BACKGROUND: Because T2 carcinoma of the gallbladder that invades perimuscular connective tissue without extension beyond serosa or into the liver has a hope for longterm survival, we attempted to clarify significant prognostic factors with respect to tumor- and surgery-related variables. STUDY DESIGN: Of 65 patients with gallbladder carcinoma who had undergone surgical resection from 1983 to 1999, 28 had T2 carcinoma histologically proved. The significance of variables for survival was examined by the Kaplan-Meier method and log-rank test followed by multivariate analyses using Cox's proportional hazard model. RESULTS: There were 17 patients with stage II carcinoma (T2 N0 M0), 6 with stage III (T2 N1 M0), and 5 with stage IVB. Lymph node metastasis was present in 11 patients (39%) and it reached to the peripancreatic head region (N2) in 5 of them. Lymphatic, venous, and perineural invasions were found in 68%, 57%, and 43%, respectively. With respect to tumor factors, the absence of perineural invasion (Odds ratio [OR] 16.77, 95% confidence interval [CI] 2.17-129.94, p = 0.0069), absence of lymph node metastasis (OR 15.00, 95% CI 2.08-108.33, p = 0.0073), and stage II (II versus III and IVB, OR 15.00, 95% CI 2.08-108.33, p = 0.0073) were significant factors related to good postoperative survival in the multivariate analysis. Surgical procedure (radical resection versus cholecystectomy, OR 4.31, 95% CI 1.34-13.82, p = 0.0142) and surgical margin (OR 7.41, 95% CI 2.19-25.13, p = 0.0013) were significant factors in the univariate analysis. Cancer-free surgical margins provided a significantly better survival (5-year survival rate, 62%); none with cancer-positive surgical margins survived for more than 27 months. In the multivariate analysis, surgical procedure was significant (OR 25.49, 95% CI 1.62-400.72, p = 0.021). Radical surgery, including extended cholecystectomy (resection of the gallbladder together with the gallbladder bed of the liver) and anatomic resection of liver segment 5 and of the lower part of segment 4, gave a significantly better 5-year survival rate than cholecystectomy (59% versus 17%). The 5-year survival rate after radical resection in patients with stage II was 75%; that in patients with stage III and IVB was 33%. CONCLUSIONS: Results suggest that radical surgery is the treatment of choice for patients with T2 carcinoma of the gallbladder. The presence of lymph node metastasis, perineural invasion, or both suggests the necessity of additional treatment after radical surgery.     

腹腔镜胆囊切除术意外胆囊癌的诊断与治疗:附23例报告

目的:探讨腹腔镜胆囊切除术(LC)意外胆囊癌的诊断和治疗。方法:回顾性分析1998年1月—2007年1月收治的23例意外胆囊癌患者的临床资料。结果:15例术中快速冷冻病理证实为胆囊癌,其中13例中转开腹行胆囊癌根治术;8例术后病理证实,其中7例行二次开腹手术。全组术后5年生存率为78.3%,患者预后与其临床分期密切相关。结论:意外胆囊癌多为早期胆囊癌,高危病例应重视术中快速病理检查及标本检查;T1b-T2期宜扩大根治,晚期患者视情况行根治性手术或姑息治疗。     

手术切除的T4卫星灶非小细胞肺癌的预后分析

目的 研究手术治疗后T4卫星灶非小细胞肺癌的生存和预后.方法 回顾性分析1995年1月至2005年3月经手术切除的42例T4卫星灶N0-2M0非小细胞肺癌患者的术后生存情况,评价各临床病理因素与预后的关系,并与同期32例手术切除的T4局部器官侵犯N0-2M0的非小细胞肺癌进行生存比较.结果 T4卫星灶组无手术死亡,术后早期并发症率为14.3%,1、3、5年生存率分别为76.2%、57.1%和46.0%;T4局部器官侵犯组术后早期并发症率为28.1%,1、3、5年生存率分别为62.3%、31.5%和20.0%;两组生存率有明显差异(P<0.05).根据淋巴结转移情况进一步分组,两组中N0M0患者的生存率均高于同组的N1-2M0患者(P<0.05).单因素分析显示,组织学类型、原发灶大小、有无淋巴结转移及是否术后辅助化疗与T4卫星灶患者的5年生存率相关;多因素分析显示原发灶大小、有无淋巴结转移及是否接受术后化疗是独立的预后影响因素.结论 原发灶直径3 cm、淋巴结转移以及未接受术后化疗的T4卫星灶非小细胞肺癌预后不佳,经手术完全切除的T4卫星灶非小细胞肺癌的预后好于T4局部器官侵犯者.     

30例胆囊癌患者行腹腔镜胆囊切除术后的生存分析

目的：探讨不同病理分期胆囊癌患者经腹腔镜切除胆囊的生存率和生存期以及可行性。方法：对1995年1月～2006年6月经腹腔镜意外发现的胆囊癌30例患者进行TNM分期,其中T1a9例,T1b6例,T2期3例,T3期12例,均接受了腹腔镜胆囊切除术,术后接受定期检查和随访,观察其不同病理分期的生存率和生存期,并进行生存分析。结果：T1a期和T1b期术后的生存率均为100%,生存期分别为（80.56±10.28）个月和（79.67±19.87）个月,无统计学差异。T2期和T3期胆囊癌术后生存率分别为100%和36.36%,生存期分别为（28.00±6.93）个月和（23.80±5.22）个月,显著低于T1a和T1b期。结论：T1a和T1b期胆囊癌患者经腹腔镜切除胆囊是可行的,生存率高、生存期长。对T2和T3期胆囊癌患者必须采用开腹手术。     

Surgical treatment of gallbladder cancer

Gallbladder cancer is usually a fatal illness because early stages of this carcinoma cause no specific signs or symptoms. Although the best chance of cure for gallbladder cancer remains incidental discovery, radical resection of the gallbladder, with the adjacent liver, adherent structures, plus a regional lymphadenectomy, has been suggested to improve survival. We retrospectively analyzed all patients with gallbladder cancer who were treated surgically at Mayo Clinic (Rochester) between 1984 and 2000. There were 131 patients for whom complete survival information was available. Patients who underwent a radical cholecystectomy had a significantly longer median survival (24 months) than patients who had a simple cholecystectomy (6 months) or noncurative treatment (4 months) (P < 0.0001). The radical cholecystectomy group had significantly longer survival than the simple cholecystectomy group for all American Joint Committee on Cancer (AJCC) stages except stage I. Of the different variables tested in a univariate analysis (sex, surgical treatment modality, AJCC stage, tumor grade, jaundice, hyperbilirubinemia, and adjuvant therapy), all variables except sex, tumor grade, and adjuvant therapy were statistically significant predictors for the survival of patients with gallbladder cancer. AJCC stage and surgical treatment modality were the only significant predictors in a multivariate analysis. Our results support radical surgical resection for the treatment of gallbladder cancer to improve patient survival. Presented at the Forty-Fourth Annual Meeting of The Society for Surgery of the Alimentary Tract, Orlando, Florida, May 18–21, 2003 (oral presentation).     

Should suspected early gallbladder cancer be treated laparoscopically?

Early gallbladder cancer (EGC), defined as T1 and T2 disease, is frequently curable when completely excised without bile spillage. The objective of the present study was to determine what effect initial laparoscopic cholecystectomy has on outcome in patients with EGC. Of 89 patients referred to our institution with gallbladder cancer over an 11-year period, 26 had undergone initial laparoscopic cholecystectomy. Sixteen of the 26 patients had T1 or T2 disease and are the subjects of this report. These patients were reviewed retrospectively to assess preoperative diagnosis, intraoperative bile spillage, and outcome (recurrence and survival). In addition, the Western literature was reviewed to determine the impact of initial laparoscopic cholecystectomy on recurrence and survival of patients with EGC. Six patients had a preoperative ultrasound consistent with a mass in the gallbladder wall. Seven (44%) had documented bile spillage during the laparoscopic cholecystectomy. T stage based on the laparoscopic cholecystectomy was T1 (n = 1) and T2 (n = 15). Twelve patients underwent reexploration of whom seven underwent further radical excision (gallbladder liver bed resection and extensive lymphadenectomy). After a mean follow-up of 20.1 months (range 4 to 39 months), 69% of patients have had a recurrence or died. Three patients had a port-site recurrence. Five (71%) of seven patients with bile spillage at laparoscopic cholecystectomy have had a recurrence or died of disease. A review of the Western literature on EGC initially removed by laparoscopic cholecystectomy (including the present series) yielded 21 patients with T1 and 42 patients withT2 disease. One-year Kaplan-Meier survival (T1 = 89%, T2 = 71%) and 3-year Kaplan-Meier survival (T1 = 47%, T2 = 40%) of these patients is worse than prior reports for open cholecystectomy. An initial laparoscopic cholecystectomy with its potential for bile spillage can convert potentially curable EGC to incurable disease. Patients with preoperative findings suspicious for gallbladder cancer should undergo open exploration with intent to perform a radical cancer operation as a primary procedure if the diagnosis is confirmed intraoperatively. Presented at Forty-Second Annual Meeting of The Society for Surgery of the Alimentary Tract, May 20–23, 2001, Atlanta, Ga (oral presentation).