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目的探讨不同手术方式、术后辅助化放疗对进展期胆囊癌(GBC)患者预后的影响。方法回顾性分析2002年1月至2011年12月收治的95例GBC患者的临床资料,随访生存期并进行生存分析。结果 GBC患者总体中位生存时间17.79个月,其中根治性切除(R0)组为39.58个月。R0切除组1、3、5年生存率分别为87%、54%、40%,非根治性切除组中,R1切除组分别为40%,4%,0,R2切除组分别为18%,0,0,姑息手术组分别为16%,0,0,时序检验表明4组生存率差异具有统计学意义(P=0.000)。TNMⅢa期、Ⅲb期GBC患者根治切除组1、3、5年生存率为93%、58%、39%和76%、42%、38%,高于非根治性切除组(47%,5%,0和38%,3%,0),差异有统计学意义(P=0.000,P=0.001)。行R0切除的患者术后辅助治疗组的1、3、5年生存率与单纯手术组比较,差异无统计学意义(P=0.373);TNM分期分层分析显示,对T分期T_3/T_4病变、N分期N1病变行R0切除的患者,单纯手术组与术后化疗组、术后化疗联合放疗组的生存率比较差异具有统计学意义(P=0.006,P=0.022)。结论R0切除是改善GBC患者预后、延长生存期最有效的方法,辅助放化疗总体有效率低,但对T_3/T_4、N1病变R0切除术后可推荐适当的辅助化、放疗。
Objective To investigate the effect of different operation methods and postoperative adjuvant chemotherapy on the prognosis of patients with advanced gallbladder carcinoma (GBC). Methods The clinical data of 95 patients with GBC admitted from January 2002 to December 2011 were retrospectively analyzed. Survival was followed up and survival analysis was performed. Results The overall median survival time of GBC patients was 17.79 months, of which the radical resection (R0) group was 39.58 months. The 1, 3, 5-year survival rates of R0 resection group were 87%, 54% and 40% respectively. In the non-radical resection group, R1, R1, and R2 groups were 40%, 4% 0,0, and palliative surgery were 16%, 0, 0, respectively, and the time-series tests showed that the survival rates of the four groups were statistically significant (P = 0.000). The 1, 3, 5-year survival rates were 93%, 58%, 39% and 76%, 42% and 38% in radical resection of GBC patients with stage IIIb and stage IIIb GBC, respectively, which were significantly higher than those in non-radical resection group , 0 and 38%, 3%, 0), the difference was statistically significant (P = 0.000, P = 0.001). There was no significant difference in the 1, 3 and 5-year survival rates between patients in the R0 resection group and those in the simple operation group (P = 0.373). TNM staging showed that the T 3 / T 4 lesions (P = 0.006, P = 0.022). There was significant difference in the survival rate between the surgery group and postoperative chemotherapy group and postoperative chemotherapy plus radiotherapy group. Conclusions R0 resection is the most effective method to improve the prognosis and prolong the survival of patients with GBC. The total effective rate of adjuvant chemoradiation and chemotherapy is low. However, proper adjuvant radiotherapy may be recommended after resection of T0 / T_4 and N1 tumors.