胆囊腺鳞癌29例临床诊治经验分析

目的回顾性分析胆囊腺鳞癌的临床病理特点及诊治经验,初步探讨男性和女性胆囊腺鳞癌患者发病及预后的差异。方法以2000年1月至2015年12月收治的29例胆囊腺鳞癌患者的临床资料为研究对象,分男女患者组对术前的影像学、实验室指标,术后病理特征;手术方式及生存时间进行统计分析。计量资料采用x珋±s表示,采用student’t检验(正态分布)或秩和检验(非正态分布);计数资料以百分比(%)表示,采用χ2检验或Fisher精确概率法。以SPSS统计软件18.0为分析手段,P0.05为差异有统计学意义。结果 29例患者中,26例行根治性手术,3例行姑息性手术,肿瘤标记物水平、肿瘤大小、分期、是否合并结石、局部侵犯和远处转移程度,男女组间差异均无统计学意义(P0.05),术后病理:Her-1阳性9例(9/11),Her-2阳性5例(5/11),CK18阳性8例(8/9),CK19阳性7例(7/8),VEGF 3例(3/3),Heptocyte阳性0例(0/5),术后总生存期为(4.56±1.67)个月,其中男患者组(3.63±1.54)个月,显著低于女患者组(5.42±1.30)个月,差异具有统计学意义(P=0.002)。结论胆囊腺鳞癌临床罕见、恶性程度高、临床表现缺乏特异性,多以局部侵犯为主,手术是目前主要的治疗手段,男女虽发病率无显著差异,但预后具有一定差异。

Clinical Analysis of Diagnosis and Treatment Experiences of Gallbladder Adenosquamous Carcinoma,report of 29 cases

Objective Retrospective analysis of the clinical pathological characteristics and treatment experience of gallbladder adenosquamous carcinoma was performed , to investigate pathogenetic and prognostic differences between male and female patients with gallbladder adenosquamous carcinoma . Methods 29 patients with gallbladder adenosquamous carcinoma admitted between Jan 2000 to Dec 2015 were enrolled in the study.Statistical analysis were performed by using SPSS 18.0 statistical software .Measurement data were presented as mean ±standard deviation and were examined by using Student t test ( normal distribution ) or rank sum test ( non-normal distribution ) between male group and female group , including preoperative imaging, laboratory indicators, pathological characteristics , operation mode and postoperative survival .Count data were presented as percentage (%) and were examined by using chi square test or Fisher ’ s exact probability method.A P value of <0.05 was considered as significant difference . Results Radical resection was performed in 26 cases, while palliative resection of 3 cases.There were no significant difference between male and female group, including tumor markers, tumor size, staging, with/without calculi, local invasion and distant metastasis (P>0.05).There were 9 cases of Her-1 positive (9/11), 5 cases of Her-2 positive (5/11), 8 cases of CK18 positive (8/9) , 7 cases of CK19 positive (7/8), 3 cases of VEGF positive (3/3) and none of Heptocyte positive (0/5) by postoperative pathological examination.The overall survival was (4.56 ±1.67) months.The survival in male group was (3.63 ±1.54) months, which was significantly shorter than (5.42 ± 1.30) months in female group, with significant difference ( P =0.002). Conclusions Adenosquamous carcinoma of gallbladder is a rare and high malignancy, which is lack of specific clinical manifestations and inclined to invade regionally.Surgery remain the effective treatment of such disease at present.There is different prognosis between male and female patients , however with similar morbidity .