51例意外胆囊癌临床分析

目的分析意外胆囊癌(UGC)患者的临床特征及手术疗效。方法收集北京大学人民医院自1990年6月至2012年4月收治的51例意外胆囊癌患者的病历资料,对其临床特征、手术疗效以及影响预后的因素进行分析。结果 51例意外胆囊癌均经冰冻或石蜡切片病理证实,其中腺癌47例(92.2%),鳞癌2例(3.9%),神经内分泌癌1例(2.0%)及小细胞癌1例(2.0%);根据Nevin分期标准,Ⅰ期5例,Ⅱ期13例,Ⅲ期15例,Ⅳ期16例,Ⅴ期2例;31例(60.8%)改行胆囊癌根治术或扩大根治术,18例(35.3%)仅行胆囊切除术,另有2例行姑息性手术;术后随访33例(64.7%),患者中位生存时间13月(2~60月);Nevin分期(P=0.001)、手术方式(P=0.026)是影响UGC预后的独立因素;根治手术组患者较非根治手术组患者生存率差异有统计学意义(χ2=3.923,P0.05)。结论绝大多数意外胆囊癌患者的病理诊断为腺癌,行根治手术可延长患者的生存时间。应根据病理分期,结合患者自身情况选择切实有效的手术治疗手段。

Clinical analysis of 51 cases of unsuspected gallbladder carcinoma

Objective To analyze the clinical features and surgical treatment of unsuspected gallbladder carcinoma （UGC）. Methods Clinical data of 51 patients with UGC in our hospital from Jun 1990 to Apt 2012 were collected. The clinical characteris- tics, surgical treatment and prognostic factors were analyzed. Results All cases of UGC were confirmed by pathological diagnosis with frozen or paraffin sections, with 47 cases of adenocarcinoma （92.2%） , 2 cases of squamous cell carcinoma （3.9%） , 1 case of neu- roendocrine carcinoma （2.0%） and 1 case of small cell carcinoma （2.0%）. According to the Nevin staging system, there were 5 ca- ses of Stage I , 13 cases of Stage Ⅱ , 15 cases of Stage Ⅲ, 16 cases of Stage 1V and 2 cases of Stage V. 31 patients （60.8%） un- derwent radical cholecystectomy or extended cholecystectomy, 18cases （35.3%） underwent simple cholecystectomy, and 2 cases un- derwent palliative operations such as biopsy, stent or T tube drainage. Postoperative follow-up of 33 patients （64.7%） showed that the median survival time was 13 months （2 - 60 months）. Nevin staging （ P = 0. 001 ） and operative method （ P = 0. 026 ） were independ- ent prognostic factors of UGC. Survival rate was more higher for the patients who underwent radical surgery （ X2 = 3. 923, P 〈 0. 05 ）. Conclusions Adenocarcinoma is the most frequent type of UGC. Radical surgery can prolong the survival time of UGC patients. Prop- er surgical treatment should be selected for UGC patients based on pathological stage and patients＇ own characteristics.