摘要
目的探讨影响术后病理发现意外胆囊癌患者预后的危险因素,为该类患者治疗决策提供指导,以期改善该部分患者的预后。方法收集我院2008~2016年收治的80例行二次手术治疗的术后意外胆囊癌患者的病历资料,应用Kaplan-Meier单因素生存分析及Cox多因素回归分析方法对相关危险因素进行分析,计量资料采用t检验,计数资料采用2检验。结果 80例意外胆囊癌中,男18例,女62例,年龄30~80岁,平均年龄(58.44±1.12)岁;术后生存期:1~89个月,中位生存时间:13.0个月,1、3、5年生存率分别为59.9%、41.7%和33.4%。单因素分析结果表明,患者术后生存期与初次手术T分期、病理分化程度、初次术后病灶有无残留、二次术后N分期,二次术后切缘有关;而与性别、年龄及二次手术时间无关。多因素分析表明,患者预后主要与初次术后是否病灶残留、N分期和二次手术切缘有关。同时进一步分析发现,在初次术后病灶残留者中,二次手术时间是影响该部分患者的重要预后因素。结论初次手术有无病灶残留和二次术后手术切缘是影响意外胆囊癌预后的重要因素。对有病灶残留的意外胆囊癌患者,应尽早进行二次根治术。规范化的病历记录及病理报告对再次手术决策具有重要参考价值。
Objective To explore the prognostic risk factors of unsuspected gallbladder carcinoma after cholecystectomy,provide guidance for the treatment of those patients and improve the overall prognosis.Methods All patients with incidence gallbladder carcinoma who underwent reoperation at our hospital from 2008 to 2016 were collected.The related risk factors were analyzed by Kaplan-Meier single factor and Cox multivariate regression analysis,the difference of measurement data was measured with t-test.Theχ2 test was used to measure the enumeration data.Results A total of 80 patients of unsuspected gallbladder carcinoma was enrolled,including 18 males and 62 females,aged 30-80 years old.The overall survival time ranged from 1 to 89 months.The median survival time was 13.0 months.The 1,3,5 year survival rate was 59.9%,41.7% and 33.4%,respectively.The results of univariate analysis showed that the postoperative survival time was related to the T stage,grade of pathology,the residual disease,the second postoperative N stage and margin status,whereas no relation with the secondary operation interval time,age and gender.The results of multivariate analysis showed the prognosis of patients was influenced primarily by the residual disease and the margin status of the secondary operation.In addition,we found that the second operation interval time was an important prognostic factor for patients with residual disease.Conclusion Residual disease and surgical margin status are important factors influencing the prognosis of incidental gallbladder carcinoma.For patients with residual disease,early radical resection should do as soon as possible.Standardized medical records and pathological reports play an important role in reoperation decision-making.
作者
孟强劳
王林
张瑞
蔡慧强
李起
陈晨
耿智敏
MENG Qianglao;WANG Lin;ZHANG Rui;CAI Huiqiang;LI Qi;CHEN Chen;GENG Zhimin(Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi ＇an Jiaotong University, Xi＇ an 710061 ,China)
出处
《西部医学》
2018年第7期966-970,共5页
Medical Journal of West China
基金
国家自然科学基金(81572420)
关键词
意外胆囊癌
二次手术时间
手术切缘
病灶残留
预后
Unsuspected gallbladder carcinoma
The time of reoperation
Surgical margin
Residual disease
Prognosis
