143例原发性胆囊癌外科诊疗及预后影响因素分析
摘要
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2002年1月～2008年12月间就诊于我院143例胆囊癌患者的临床、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:143例中76例患者行手术治疗,非手术治疗以及放弃治疗者67例。获得随访123例(86%),AJCCI期与II期患预后远好于AJCCIII期与IV期患者。多因素分析显示:是否存在梗阻性黄疸症状,肿瘤AJCC分期及治疗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高早期诊断率,两者均为提高胆囊癌患者预后的关键措施。
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 143 cases of PCG admitted in our hosptial from January 2002 to December 2008. 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: 76 cases were followed up, AJCC I and II have a much better prognosis than, AJCC III and IV. Multivariate analysis revealed that the symptom of obstructive jaundice, AJCC 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.
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 143 cases of PCG admitted in our hosptial from January 2002 to December 2008. 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: 76 cases were followed up, AJCC I and II have a much better prognosis than, AJCC III and IV. Multivariate analysis revealed that the symptom of obstructive jaundice, AJCC 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.
引文
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[1]黄志强,黄晓强.肝胆胰外科聚焦.北京:人民军医出版社, 2005: 392 - 398.
[2]郑树森,梁廷波,秦运生.原发性胆囊癌98例疗效及预后评析.中华外科杂志, 2004, 42 (9) : 517-519
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[2]邹声泉,张林.全国胆囊癌临床流行病学调查报告.中国实用外科杂志, 2000, 20 (1) : 43–46.
[3]郑树森,梁廷波,秦运生.原发性胆囊癌98例疗效及预后评析.中华外科杂志, 2004, 42 (9) : 517-519.
[4]肖卫东,彭承宏,周光文,等. NevinⅣ?Ⅴ期胆囊癌62例外科治疗.中华普通外科杂志, 2004, 19 (10) : 589-591.
[5] Carriaga MT, Henson DE. Liver, gallbladder, extrahepatic bile ducts, and pancreas. Cancer 1995; 75: 171-190.
[6] Wilkinson DS. Carcinoma of the gall-bladder: an experience and review of the literature. Aust NZ J Surg 1995; 65: 724-727.
[7] Kaneoka Y, Yamaguchi A, Isogai M, et al. Hepatoduodenal ligament invasion by gallbladder carcinoma; histologic pattens and recommendation. World J Surg, 2003, 27: 260-265.
[8] Reddy SK, Marroquin CE, Kuo PC, et al. Extended hepatic resection for gallbladder cancer[J]. Am J Surg, 2007, 194 (3) : 355-361.
[9] AJCC Cancer Staging Manual, Sixth Edition 2002.
[10]石景森,刘刚.胆囊癌与胆囊结石的相关研究.实用肿瘤杂志, 2005, 20 (1) : 10-11.
[11]张水军,李捷.原发性胆囊癌的早期诊断[ J ].临床外科杂志, 2005, 13: 42.
[12]Kaushik SP. Current perspectives in gallbladder carcinoma. Journal of Gas- troenterology and Hepatology, 2001, 16 (8) : 848 - 854.
[13]Varshney S, Buttirini G, Gup ta R. Incidental carcinoma of the gallbladder. European Journal of Surgical Oncology, 2002, 8 (1) : 4-10.
[14]王贤成.马鞍山市花山区1995~1996年恶性肿瘤发病率分析.安徽医学, 2000, 21: 35-36.
[15]石景森.我国胆囊癌的发病情况及外科处理.肝胆胰外科杂志, 1999, 11: 51-52.
[16]Bartlett DL, Ramanthan RK, Ben Josef E. Cancers of the biliary tree. In: DeVita J, V. T. , Lawrence TS, Rosenberg SA, eds. Cancer: Principles & Practice of Oncology. 8th ed: Wolters Kluwer; Lippincott Williams & Wilkins; 2008: 1156-1186.
[17]Nishimura A, Shirai Y, Hatakeyama K . High coincidence of Mirizzi syndrome andgallbladder carcinoma. Surgery, 1999, 126 (3) : 587-588 .
[18]张林,邹声泉.胆囊腺瘤腺癌中的DNA含量和基因表达.中华肝胆外科杂志, 2004, 10 (7) : 460-462 .
[19]Nabatame N, Shirai Y, Nishimura A, et al . High risk of gallbladder carcinoma in elderly patients with segmental adenomyomatosis of the gallbladder [ J ]. J Exp Clin Cancer Res, 2004, 23 (4) : 593-598 .
[20]Nishimura A, Shirai Y, Hatakeyama K . Segmental adenomyomatosis of the gallbladder predisposes to cholecystolithiasis[ J ]. J Hepatobiliary Pancreat Surg, 2004, 11 (5) : 342-347 .
[21]ElnemrA, Ohta T, Kayahara M, et al . Anomalous pancreaticobiliary ductal junction without bile duct dilatation in gallbladder cancer [ J ]. Hepatogastroenterology, 2001, 48 (38) : 382-386 .
[22]Matsubara T, Sakurai Y, Zhi L Z, et al . TK-ras and p53 genemutations in noncancerous biliary lesions of patients with pancreaticobiliary maljunction [ J ]. J Hepatobiliary Pancreat Surg, 2002, 9 (3) : 312-321 .
[23]Wang H H, AfdhalN H, Wang D Q. Overexpression of estrogen receptor increases hepatic cholesterogenesis, leading to biliary hypersecretion in mice [ J ]. J Lipid Res, 2006, 47 (3) : 778-786 .
[24]Baskaran V, Vij U, Sahni P, et al . Do the progesterone receptors have a role to play in gallbladder cancer? [ J ]. Int J Gastrointest Cancer, 2005, 35 (1) : 61-68 .
[25]Batra Y, Pal S. Gallbladder cancer in India: a dismal picture[J ] . J Gastroenterol Hepatol, 2005, 20 (2) : 309-314.
[26]陈炯,徐荣楠,余建伟,等.性激素受体在胆囊癌中的表达研究[ J ].中华普通外科杂志, 2001, 16 (5) : 299-300 .
[27]Donohue JH. Present status of the diagnosis and treatment of gallbladder carcinoma. J Hepatobiliary Pancreat Surg, 2001, 8 (6) : 530-534.
[28]Fujita N, Noda Y, Kobayashi G, et al. Diagnosis of the depth of invasion of gallbladder carcinoma by EUS. Gastrointest Endosc, 1999, 50 (5) : 659-663.
[29]吴钢.蔡端.原发性胆囊癌的影像学诊断分析.肝胆胰外科杂志. 2001. 13: 12-13.
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