摘要
目的基于循证医学模式为1例评估为局部进展期的胆囊癌术后复发病人制定治疗方案。方法上海交通大学医学院附属新华医院2020年3月收治1例胆囊癌术后肝十二指肠韧带淋巴结复发侵犯门静脉主干及肝总动脉后壁病人,胆道肿瘤多学科综合治疗协作组(MDT)在详细评估病情后,检索国内外主流医学文献数据库,寻找循证医学证据并进行评价,结合病人实际情况,最终拟定以根治切除为目标的转化治疗策略。结果根据所获证据,成功对病人实施转化治疗。经4周期AG方案(白蛋白结合型紫杉醇125 mg/m^(2)+吉西他滨1000 mg/m^(2),第1、8天静脉给药,21 d/周期)化疗后,影像学评估达部分缓解,存在R0切除可能。因此进行胆囊床肝楔形切除术+胆总管切除+区域淋巴结清扫术+胆管空肠吻合术,达到R0切除。术后病理学检查提示完全缓解。目前随访6个月无复发。结论对于胆囊癌术后复发的病例,应仔细进行可切除性评估,对直接手术获益不明显的病人,可考虑以化疗为主的转化治疗策略,以期实现根治性切除。
ObjectiveTo develop a treatment plan based on evidence-based medicine for a case of locally advanced gallbladder cancer with postoperative recurrence.Methods visited department of general surgery affiliated to Xin Hua Hospital in March 2020.Contrast-enhanced abdominal CT and FDG-PET confirmed metastatic lymph nodes around the main portal vein and the common hepatic artery.Multidisciplinary team for biliary tract cancer evaluated the disease condition and searched evidences from the mainstream medical literature database.Finally,a conversion therapy strategy was formulated based on evidences and actual situation.Results intravenous albumin-bound paclitaxel,125 mg/m^(2),followed by gemcitabine,1000 mg/m^(2),on days 1 and 8 of each 21-day treatment cycle.Partial remission was achieved after 4 cycles.Then R0 resection was performed successfully by wedge resection of gallbladder bed and lymphadenectomy and choledochojejunostomy.Postoperative pathology indicated complete remission.There was no recurrence after6 months follow-up.ConclusionFor patientswith recurrent gallbladder cancer,the resectabilityshould be accurately assessed.For patients with noobvious benefit from upfront surgery,the conversiontherapy strategy based on chemotherapy can beconsidered to achieve radical resection.
作者
吴向嵩
杨自逸
龚伟
WU Xiang-song;YANG Zi-yi;GONG Wei(Department of General Surgery,Xin Hua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai Key Laboratory of Biliary Tract Disease Research,Shanghai Research Center of Tract Disease,Research Institute of Biliary Tract Disease,Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China)
出处
《中国实用外科杂志》
CAS
CSCD
北大核心
2021年第3期306-309,319,共5页
Chinese Journal of Practical Surgery
基金
国家自然科学基金(No.81974371)
上海市人才发展资金资助计划(No.2018086)
上海市卫生计生系统优秀青年医学人才培养计划(No.2018YQ10)。
关键词
胆囊癌
局部进展期
转化治疗
循证医学
化疗
gallbladder cancer
locally advanced
conversion therapy
evidence-based medicine
chemotherapy
