不同部位胆囊癌扩大根治术的价值

目的 探讨扩大的手术方式对胆囊癌NevinⅣ期患者R0切除率及患者中位生存期的影响。方法 将91例NevinⅣ期胆囊癌患者分为胆囊底体部痛和胆囊颈部癌，分别施行扩大清扫术、常规清扫术及姑息手术，并对中位生存期、淋巴结转移率、R0切除率等指标进行比较。计量资料采用重复测量方差分析或配对t检验，计数资料采用配对x2检验。结果 扩大清扫术组中位生存期（月）明显高于常规手术组和姑息手术组，胆囊底体部癌的中位生存期分别为(27.1±2.4)、（10.7±2.2）、(4.7±2.2)个月，胆囊颈部癌的中位生存期分别为（8.5±2.1）、(6.7±1.9)、(3.1±1.1)个月；胆囊底体部癌和颈部癌的R0切除率不同，胆囊底体部癌的扩大清扫术和常规手术RO切除率分别为16/18(88％)和7/12(58％)，胆囊颈部癌的扩大清扫术和常规清扫术RO切除率分别为6/16(38％)和3/13(23％)；胆囊底体部癌和胆囊颈部癌淋巴结转移率分别为：No.12a (64％，81％，P=0.088),No.12b(58％,83％,P=0.01),No.13( 32％,70％,P=0.000),No.14( 17％,18％,P=0.961),No.16(12％,17％,P=0.392),No.8a(28％,41％,P=0.215) No.8p(22％,42％,P=0.051)。结论 NevinⅣ期胆囊底体部癌扩大清扫术的中位生存期、RO切除率等均高于胆囊颈部癌。

Expanded radical resection for gallbladder cancer at different portions

Objective To explore the value of expanded radical resection for gallbladder cancer located respectively at body and bottom of the gallbladder and at the neck.Methods In this study,91 cases of gallbladder cancer were macropathologically divided into two groups, one with the lesion at the body and bottom of the gallbladder and the other at the neck, survival analysis was made accordingly. Three different kinds of resection were performed: the expanded radical resection, the standard radical resection and palliative operation. Results The overall median survival rate of patients undergoing expanded radical operation was significantly longer than that of the cases doing other two procedures, that was 27. 1 ± 2. 4,10. 7 ±2. 2,4. 7 ±2.2 (months) respectively for body and bottom cancer, and 8.5 ±2. 1,6. 7 ± 1.9,3.1 ± 1.1 (months) respectively for neck cancer. For cancer at the body and bottom RO was achieved by expanded radical resection in 16/18(88％ ) cases and by standard radical resection in 7/12(58％ ) cases, while for cancer at the neck it was in 6/16(38％ ) cases, and in 3/13 (23％)cases only. Conclusions The median survival time is longer and RO resection rate is higher in patients with the cancer at the body and bottom than these at the neck of the gallbladder.