意外胆囊癌的临床病例特点及生存分析

发布时间：2018-05-03 07:36

  本文选题：意外胆囊癌 + 临床特征　； 参考：《浙江大学》2015年博士论文

【摘要】：目的：在胆道系统恶性肿瘤之中,胆囊癌的发病率最高。胆囊癌病人是否能长期生存的重要预后因素是诊断时疾病已经发展到哪一阶段以及是否能完整切除。近年来,随着腹腔镜胆囊手术的普及,特别是“意外胆囊癌”的现象得到重视。纳入本中心意外胆囊癌病例,进行意外胆囊癌病例临床特征分析,描绘意外胆囊癌病人临床特征图谱,更进一步进行意外胆囊癌病人生存分析,以期得出有一定临床价值的结果。 方法：纳入本中心意外胆囊癌病人,记录患者基本信息(包括手术时的年龄、患者性别、主诉、临床诊断),影像学检查结果,手术方式,术后病理结果及分期,临床结局(包括住院日、死亡时间、最后随访时间、辅助治疗等)等,使用Kaplan-Meier方法建立生存曲线,Log-rank方法进行比较。单因素的生存分析使用单因素COX回归方法。进一步多因素分析使用多因素COX回归模型,所有分析P0.05为显著。 结果：一共有40名病理结果为胆囊腺癌的意外胆囊癌病人纳入本研究(33名女性/7名男性,年龄中位数为58岁)。切除胆囊的病理报告结果显示有24名病人原发肿瘤浸润程度为T2,术中确诊胆囊癌的为11例,行胆囊癌根治手术的病人共21例。T2期及以上等级的意外胆囊癌病人,1年生存率为69.4%,3年生存率为59.3%。Ⅱ期、Ⅲ期、ⅣV期病人1年生存率分别为76.7%、49%和0%(P0.05)。T2期的病人行根治术与未行根治术病人3年生存率分别为71.1%和58.3%(P0.05)。T3期的病人行根治术与未行根治术病人1年生存率分别为50%和66.7%(P0.05)。淋巴结转移病人术后生存期显著低于无淋巴结转移病人(RR=0.160,95%CI为0.027-0.946,P=0.043)。发生远处转移病人术后生存期显著低于无远处转移的病人(RR=0.124,95%CI为0.020-0.749,P=0.023)。 总结：Ⅱ、Ⅲ、Ⅳ期意外胆囊癌病人预后显著不同,随分级越高,1年生存率显著下降(P0.05)。Tlb、T2及T3期无远处转移的意外胆囊癌病人是否行根治术,对其术后长期生存无显著影响(P0.05)。在多因素分析中,淋巴结转移和远处转移是独立的影响意外胆囊癌病人术后生存的显著因素,使得生存率显著下降(P0.05)。
[Abstract]:Objective: among the malignant tumors of the biliary system, the incidence of gallbladder carcinoma is the highest. An important prognostic factor for long-term survival in patients with gallbladder cancer is the stage at which the disease has been diagnosed and whether it can be removed completely. In recent years, with the popularization of laparoscopic cholecystectomy, especially the phenomenon of "accidental gallbladder carcinoma" has been paid attention to. The clinical features of patients with accidental gallbladder carcinoma were analyzed, and the clinical characteristics of patients with accidental gallbladder carcinoma were analyzed. The survival analysis of patients with accidental gallbladder carcinoma was further carried out. With a view to a certain clinical value of the results. Methods: the patients with accidental gallbladder cancer were included in this study. The basic information of the patients was recorded (including age at the time of operation, sex of the patients, main complaint, clinical diagnosis, imaging examination, operative method, postoperative pathological results and stages). Clinical outcomes (including hospitalization date, death time, last follow-up time, adjuvant therapy, etc.) were compared using Kaplan-Meier method to establish survival curve and Log-rank method. Univariate COX regression was used for survival analysis. Multivariate COX regression model was used in further multivariate analysis, all of which were significant (P0.05). Results: a total of 40 patients with accidental gallbladder carcinoma with pathological findings of gallbladder carcinoma were enrolled in this study, 33 women / 7 men with median age of 58 years. The pathological results of cholecystectomy showed that the primary tumor invasion was T _ 2 in 24 patients, and 11 cases were diagnosed as gallbladder carcinoma during the operation. There were 21 cases of accidental gallbladder carcinoma with grade T 2 and above. The 1 year survival rate was 69.4, and the 3 year survival rate was 59.3%. The 1-year survival rate of patients with stage 鈪，

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