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中华肝脏外科手术学电子杂志 ›› 2021, Vol. 10 ›› Issue (02) : 165 -169. doi: 10.3877/cma.j.issn.2095-3232.2021.02.010

所属专题: 文献

临床研究

意外胆囊癌的诊治及术后生存影响因素分析
朱茂群1, 顾元龙1, 张硕1, 陈武强1, 金成1, 刘敏丰1, 钱毅1, 何友钊1, 翟年宽1, 杨军1,()   
  1. 1. 214000 江苏省无锡市,江南大学附属医院肝胆外科 无锡市肝胆外科研究所
  • 收稿日期:2020-12-17 出版日期:2021-04-10
  • 通信作者: 杨军
  • 基金资助:
    无锡市科教强卫医学工程青年人才计划(QNRC001); 江南大学公共卫生研究中心青年项目(JUPH201825); 无锡市卫计委转化医学项目(ZM007)

Diagnosis, treatments for accidental gallbladder cancer and its postoperative survival influencing factors

Maoqun Zhu1, Yuanlong Gu1, Shuo Zhang1, Wuqiang Chen1, Cheng Jin1, Minfeng Liu1, Yi Qian1, Youzhao He1, Niankuan Zhai1, Jun Yang1,()   

  1. 1. Department of Hepatobiliary Surgery, Affiliated Hospital of Jiangnan University, Wuxi Institute of Hepatobiliary Surgery, Wuxi 214000, China
  • Received:2020-12-17 Published:2021-04-10
  • Corresponding author: Jun Yang
引用本文:

朱茂群, 顾元龙, 张硕, 陈武强, 金成, 刘敏丰, 钱毅, 何友钊, 翟年宽, 杨军. 意外胆囊癌的诊治及术后生存影响因素分析[J/OL]. 中华肝脏外科手术学电子杂志, 2021, 10(02): 165-169.

Maoqun Zhu, Yuanlong Gu, Shuo Zhang, Wuqiang Chen, Cheng Jin, Minfeng Liu, Yi Qian, Youzhao He, Niankuan Zhai, Jun Yang. Diagnosis, treatments for accidental gallbladder cancer and its postoperative survival influencing factors[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2021, 10(02): 165-169.

目的

探讨意外胆囊癌诊治及腹腔镜胆囊切除术(LC)后生存影响因素。

方法

回顾性分析2010年5月至2015年3月在江南大学附属医院行LC的37例意外胆囊癌患者临床资料。其中男13例,女24例;年龄27~79岁,中位年龄61岁。Nevin分期Ⅰ期11例,Ⅱ期9例,Ⅲ期10例,Ⅳ期6例,Ⅴ期1例。患者均签署知情同意书,符合医学伦理学规定。分析患者的诊治方法及术后生存影响因素。生存分析采用Kaplan-Meier法和Log-rank检验。

结果

意外胆囊癌发生率为1.39%(37/2 653)。术前诊断为胆囊结石29例,胆囊息肉8例。术中快速病理诊断胆囊癌25例,其中6例行单纯LC,19例中转开腹行胆囊癌根治术。术后病理检查诊断胆囊癌12例,其中5例行再次开腹胆囊癌根治术。R0切除29例,R1或R2切除8例。患者术后1、3、5年生存率分别为78.3%、35.1%、29.7%。肿瘤分化程度、淋巴结转移、Nevin分期、胆囊壁厚度、手术方式与患者术后生存有关(χ2=5.871,9.981,12.231,11.291,11.321;P<0.05)。

结论

肿瘤分化程度、淋巴结转移、Nevin分期、胆囊壁厚度、手术方式是意外胆囊癌患者LC术后生存的影响因素。胆囊癌早期诊治可取得较好的临床预后。

Objective

To explore the diagnosis and treatments for the accidental gallbladder cancer and the influencing factors of the survival after laparoscopic cholecystectomy (LC).

Methods

Clinical data of 37 patients with accidental gallbladder cancer who underwent LC in the Affiliated Hospital of Jiangnan University from May 2010 to March 2015 were retrospectively analyzed. Among them, 13 patients were male and 24 female, aged from 27 to 79 years with a median age of 61 years. 11 patients were classified as Nevin stage Ⅰ, 9 cases stage Ⅱ, 10 cases stage Ⅲ, 6 cases stage Ⅳ and 1 case stage Ⅴ. The informed consents of all patients were obtained and the local ethical committee approval was received. The diagnosis, treatments and influencing factors of the postoperative survival were analyzed. Survival analysis was performed by Kaplan-Meier method and Log-rank test.

Results

The incidence of accidental gallbladder cancer was 1.39%(37/2 653). Preoperatively, 29 patients were diagnosed with gallstones and 8 cases were with gallbladder polyps. Intraoperatively, 25 cases were diagnosed with gallbladder cancer by rapid pathological examination. Among them, 6 cases were only treated with LC, and 19 cases were converted to open radical resection of gallbladder cancer. 12 cases were diagnosed with gallbladder cancer by postoperative pathological examination, including 5 cases underwent secondary open radical resection of gallbladder cancer. 29 patients underwent R0 resection, and 8 cases R1/R2 resection. The postoperative 1-, 3- and 5-year survival rates were 78.3%, 35.1% and 29.7%, respectively. Tumor differentiation, lymph node metastasis, Nevin stage, thickness of gallbladder wall and surgical procedures were significantly associated with the postoperative survival (χ2=5.871, 9.981, 12.231, 11.291, 11.321; P<0.05).

Conclusions

Tumor differentiation, lymph node metastasis, Nevin stage, thickness of gallbladder wall and surgical procedures are the influencing factors of the survival in patients with accidental gallbladder cancer after LC. Early diagnosis and treatments can achieve favorable clinical prognosis for gallbladder cancer patients.

图1 37例意外胆囊癌患者腹腔镜胆囊切除术后Kaplan-Meier生存曲线
表1 意外胆囊癌患者腹腔镜胆囊切除术后生存影响因素
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