摘要
目的比较术后诊断的意外胆囊癌(ID-GBC)与术前诊断的疑似胆囊癌(PS-GBC)患者在临床病理特征和生存率方面的差异,评估术后ID-GBC患者从胆囊切除到再次手术的时间间隔对预后的影响。方法回顾性分析2004年1月至2014年12月在上海东方肝胆外科医院行根治性手术切除的276名胆囊癌患者的临床特征、手术效果和预后情况。结果术后ID-GBC患者累计1、3、5年生存率(分别为88.8%、52.2%和33.0%)明显优于PS-GBC组(57.5%、25.7%、16.6%,P<0.05)。对术后ID-GBC患者行多因素分析发现,肿瘤分期、肝脏受侵犯和从胆囊切除术到再次手术.的时间间隔是影响预后的独立预后因素。根据再次手术的时间,将80例术后ID-GBC患者分为2周之内、2周至1个月和1个月以上3组,结果显示2周之内再手术患者的总生存期(OS)明显优于其他两组(P<0.05),而2周至1个月组和超过1个月再手术组患者的OS差异无统计学意义(P>0.05)。结论术后ID-GBC患者生存率明显优于术前诊断的疑似胆囊癌组。在综合评估有望获得根治性手术切除时,ID-GBC患者两周内接受再次手术是一项较好的治疗策略。
Objective To compare the tumor characteristics and survival between postoperative incidentally discovered gallbladder cancer(ID-GBC)and preoperatively suspected gallbladder cancer(PS-GBC).Methods The data of 276 GBC patients who underwent surgical resection with curative intent between January 2004 and December 2014 at the Eastern Hepatobiliary Surgery Hospital were retrospectively analyzed.Results The 1-,3-,and 5-year cumulative survival rates of the ID-GBC group(88.8%,52.2%,and 33.0%,respectively)were significantly better than those in the PS-GBC group(57.5%,25.7%,and 16.6%,P<0.05).In the ID-GBC group,multivariate analysis revealed that T staging,hepatic invasion and time interval from cholecystectomy to re-operation were independent prognostic factors.The overall survival(OS)in the group with the time interval within 2 weeks was significantly better than those in the other two groups(both P<0.05).However,there were no significant differences in OS between the groups with the time interval of 2 weeks to 1 month and more than 1 month(P>0.05).Conclusions Postoperative ID-GBC had significantly better survival outcomes than PS-GBC.Reoperation within two weeks in patients with ID-GBC is a good strategy.
作者
杨新伟
栗玉龙
杜晶
温志坚
杨珏
杨平华
张宝华
Yang Xinwei;Li Yulong;Du Jing;Wen Zhijian;Yang Jue;Yang Pinghua;Zhang Baohua(Department of Biliary Tract Surgery,Eastern Hepatobiliary Surgery Hospital,PLA Naval Medical University,Shanghai 200438,China;Department of Medical Health Service,PLA Naval Medical University,Shanghai 200438,China;Department of Hepatobiliary Pancreatic Vascular Surgery,No.174 Hospital of PLA,Xiamen 361003,China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2020年第2期119-123,共5页
Chinese Journal of Hepatobiliary Surgery
关键词
胆囊肿瘤
预后
意外胆囊癌
治疗策略
再手术
Gallbladder neoplasms
Prognosis
Incidental gallbladder cancer
Treatment strategy
Reoperation
