胰头后淋巴结清扫在T3、T4期胆囊癌治疗中的意义

发布时间：2019-04-26 05:00

【摘要】：研究目的通过回顾性调查T3、T4期胆囊癌临床病理特征及胆囊癌患者的预后,并分析手术淋巴结清扫对于T3、T4期胆囊癌预后的影响,帮助确定进行胆囊癌根治性手术时进行淋巴结清扫的范围,并为判断胆囊癌患者的预后提供更多的参考。研究方法回顾性分析2009年1月至2013年12月间第二军医大学东方肝胆外科医院收治的胆囊癌行手术治疗且术后经病理诊断证实病理分期处于T3、T4期的182例胆囊癌手术病例的临床与随访资料。并将入组的患者根据手术切除的范围和肿瘤的pT分期分为T3标准组、T3扩大清扫组、T4标准组、T4扩大清扫组、HPD组,分析淋巴结清扫范围对胆囊癌患者预后的影响。生存分析采用Kaplan-Meier法,比较术后并发症采用x2和Fisher确切概率法,以P0.05认为差异有统计学意义。研究结果全组pT3期118例,pT4期64例。经术后病理检查发现手术切除的淋巴结中存在肿瘤转移的146例,全组的淋巴结转移率为80.2%(146/182)。其中,pT3期118例患者中89例存在区域淋巴结转移,pT4期64例患者57例存在区域淋巴结转移,淋巴结转移率分别为75.4%、和89.1%。T3标准组共78例,中位生存时间11个月；T3扩大清扫组共40例,中位生存时间30个月；T4标准组共39例,中位生存时间8个月；T4扩大清扫组共19例,中位生存时间18个月；HPD组共6例,中位生存时间15个月。应用Kaplan-Meier法对比T3标准组、T3扩大清扫组；T4标准组、T4扩大清扫组；T4扩大清扫组、HPD组患者的术后生存时间发现。T3扩大清扫组对比T3标准组术后生存时间存在差异,该结果有统计学意义(P0.01)。T4扩大清扫组对比T4标准组术后生存时间存在差异,该结果有统计学意义(P0.01)；T4扩大清扫组对比HPD组术后生存时间的差异无统计学意义(P=0.865)。入组患者均无围手术期死亡病例。各组术后并发症发生率为T3标准组14.1%(11/78),T3扩大清扫组15.0%(6/40),T4标准组15.3%(6/39),T4扩大清扫组15.8%(3/19),HPD组50%(3/6)。相互比较后发现差异均无统计学意义(P0.05)。研究结论胆囊癌的淋巴结转移与T3、T4期胆囊癌患者预后相关。在能进行根治性手术的前提下,应扩大区域淋巴结的清扫范围。
[Abstract]:Objective to investigate retrospectively the clinicopathological features and prognosis of patients with gallbladder carcinoma in stage T 3 and T 4, and to analyze the effect of surgical lymph node dissection on the prognosis of stage T 3 and T 4 gallbladder carcinoma, and analyze the effect of lymph node dissection on the prognosis of stage T 3 and T 4 gallbladder carcinoma. It is helpful to determine the range of lymph node dissection during radical operation of gallbladder carcinoma and provide more reference for predicting prognosis of patients with gallbladder cancer. Methods from January 2009 to December 2013, the patients with gallbladder cancer who received surgical treatment from January 2009 to December 2013 in Oriental hepatobiliary surgery Hospital, second military Medical University were treated surgically and the pathological stage was confirmed by pathological diagnosis to be at T3, Clinical and follow-up data of 182 cases of gallbladder carcinoma in T4 stage. The patients in the group were divided into T 3 standard group, T 4 extended dissection group and HPD group according to the scope of surgical resection and pT staging of tumor. The effects of lymph node dissection range on prognosis of gallbladder cancer patients were analyzed. Kaplan-Meier method was used for survival analysis and x2 and Fisher exact probability method were used to compare the postoperative complications. The difference was statistically significant (P0.05). Results there were 118 cases of pT3 stage and 64 cases of pT4 stage. Postoperative pathological examination showed that 146 cases had tumor metastasis in the resected lymph nodes. The lymph node metastasis rate in the whole group was 80.2% (146 / 182), and the lymph node metastasis rate in the whole group was 80.2% (146 / 182). Among them, 89 cases had regional lymph node metastasis in pT3 stage, 57 cases had regional lymph node metastasis in 64 cases of pT4 stage, the lymph node metastasis rate was 75.4% respectively, and 78 cases in 89.1%.T3 standard group. Median survival time was 11 months; The median survival time was 30 months in T 3 extended sweep group, 39 cases in T 4 standard group, 19 cases in T 4 extended clearance group, and 6 cases in HPD group, and the median survival time was 15 months in T 4 standard group, and 19 cases in T 4 extended sweep group, with a median survival time of 18 months and a median survival time of 8 months in T 4 standard group, and 6 cases in T 3 extended clearance group, respectively. Kaplan-Meier method was used to compare T3 standard group, T3 expanded cleaning group, T4 standard group, T4 expanded cleaning group. The postoperative survival time of patients with T 4 enlarged clearance and HPD group was found to be different compared with T 3 standard group, and the survival time of T 3 group was significantly higher than that of T 3 standard group. The results were statistically significant (P0.01). There was a significant difference in the survival time between the T4 standard group and the T4 standard group (P0.01), and there was a significant difference in the survival time between the T4 standard group and the T4 standard group. There was no significant difference in postoperative survival time between HPD group and T4 expanded cleaning group (P < 0. 865). No peri-operative death was found in all the patients in the group. The postoperative complications were 14.1% (11 / 78), 15.0% (6 / 40), 15.3% (6 / 39), 15.8% (3 / 19) and 15.8% (3 / 19) in T _ 3 standard group, T _ 3 expanded cleaning group, T _ 4 standard group and T _ 4 extended cleaning group, respectively. HPD group was 50% (3 / 6). Compared with each other, the differences were not statistically significant (P0.05). Conclusion lymph node metastasis of gallbladder carcinoma is associated with prognosis of patients with stage T 3 and T 4 gallbladder carcinoma. Under the premise of radical operation, the scope of regional lymph node dissection should be expanded.
【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.8

【共引文献】