69例胆囊癌手术治疗及预后影响因素分析

目的研究原发性胆囊癌临床特征,分析探讨影响预后有关因素以指导原发性胆囊癌治疗。方法回顾性分析我院1990年1月至2003年1月手术治疗的69例胆囊癌患者临床、病理资料,并采用Kaplan-Meier模型、Log-rank检验及COX比例风险模型进行统计学分析。结果胆囊癌术后5年总体生存率为5.9%,施行根治性手术组1、2、3、5年生存率分别为67.3%、42.8%、29.4%、15.2%,与姑息手术组、对症手术组、剖腹探查组比较差异有显著统计学意义(P<0.05)。多因素分析显示:肿瘤TNM分期及手术方式与胆囊癌预后显著相关。结论胆囊癌患者尽可能施行根治性手术,多种检查方法相结合以提高早期诊断率,两者均为提高胆囊癌患者预后的关键措施。

Treatment of gallbladder carcinoma and factors influencing prognosis: a report of 69 cases

Objective To investigate the clinical characteristics of primary carcinoma of the gallbladder (PCG) and discuss factors affecting prognosis for guiding treatment of PCG.Methods A retrospective clinical analysis was made in 69 cases with PCG undergone surgical operation in our department from January 1990 to January 2003. The data were processed with statistical methods including Kaplan-Meier model, Log-rank test in univariate analyses and COX regression model in multivariate analyses. Results The overall 5-year survival rate of PCG was 5.9. The survival rate with radical resection for PCG at 1, 2, 3 and 5 years was 67.3, 42.8, 29.4 and 15.2, respectively, with statistical difference compared with that with other operations including non-radical-resection, palliative-resection and biopsy (P<0.05). Multivariate analysis revealed that TNM stage and therapeutic interventions significantly affected prognosis of PCG. Conclusions Radical resection should be selected for cases with PCG as possible; combined examination methods can improve accuracy of early diagnosis, both of which are key measures for facilitating prognosis of cases with PCG.