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目的 评价腹腔镜手术中发现的原发性胆囊癌的处理。方法 对 1996—2003 年间腹腔镜胆囊切除手术(LC)中发现的21例原发性胆囊癌患者的临床资料进行研究。21例患者中NevinⅡ期3例、Ⅲ期11例、Ⅳ期3例。将17例患者分为A、B两组,A组6例均二次开腹行胆囊癌根治术,B组11例均只行单纯LC术;对A、B两组生存率的差异进行χ2 检验和Kaplan Meier生存分析。结果 (1)21例患者中NevinⅠ期2例,至今已分别存活6个月和47个月;(2)A、B两组生存率差异有统计学意义(χ2=4 55,P=0 0328)。结论 (1)对NevinⅠ期患者可单纯行LC术;(2)对Nevin Ⅱ期或Ⅲ、Ⅳ期患者需二次开腹行胆囊癌根治术。
Objective To evaluate the treatment of primary gallbladder cancer found during laparoscopic surgery. Methods The clinical data of 21 patients with primary gallbladder cancer discovered during laparoscopic cholecystectomy (LC) from 1996 to 2003 were studied. Among 21 patients, 3 were Nevin II, 11 were III, and 3 were IV. Seventeen patients were divided into two groups, A and B. In group A, 6 patients underwent radical laparotomy for gallbladder carcinoma twice. In group B, only 11 patients underwent LC alone; differences in survival rates between group A and B were evaluated. Test and Kaplan Meier survival analysis. Results (1) There were 2 cases of Nevin I in 21 patients and they had survived 6 months and 47 months respectively. (2) There was a significant difference in the survival rate between group A and B (χ2=4 55, P=0 0328). ). Conclusions (1) For patients with Nevin I stage, LC can be performed only; (2) Patients with Nevin II or III and IV need to undergo second operation for radical gallbladder carcinoma.