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目的探讨意外胆囊恶性肿瘤(UGC)的外科治疗和预后。方法回顾性分析1996年1月—2003年12月浙江大学医学院附属第二医院外科18例UGC患者(UGC组)的临床及病理资料,并与同期有随访资料的43例手术前确诊的胆囊恶性肿瘤患者(DGC组)进行比较。结果UGC组中未侵犯浆膜者占55.6%(10/18),DGC组中肿瘤侵犯浆膜伴局部区域淋巴转移者占90.7%(39/43)。UGC组与DGC组根治性手术切除率分别为72.2%(13/18)和39.5%(17/43);根治性手术后累积5年生存率分别为54.6%和23.5%(χ2L=16.33,P<0.01)。全组61例患者根治性手术与姑息性手术后中位生存期分别为43.3个月和10.5个月(χ2L=31.10,P<0.01)。结论UGC总体预后好于术前确诊的胆囊恶性肿瘤,发现后应尽早积极进行再次根治性手术。早期诊断和再次采取手术根治能改善UGC患者的预后。
Objective To investigate the surgical treatment and prognosis of unexpected gallbladder malignancies (UGC). Methods The clinical and pathological data of 18 UGC patients (UGC group) from January 1996 to December 2003 in the Second Affiliated Hospital of Medical College of Zhejiang University were retrospectively analyzed. The data of 43 patients with preoperatively diagnosed gallbladder Malignant tumor patients (DGC group) were compared. Results In the UGC group, 55.6% (10/18) did not invade the serosa, while 90.7% (39/43) in the DGC group had tumor invasion serosa with local lymph node metastasis. The radical resection rates of UGC group and DGC group were 72.2% (13/18) and 39.5% (17/43), respectively. The cumulative 5-year survival rates after radical operation were 54.6% and 23.5% (χ2L = 16.33, P <0.01). The median survival of the 61 patients was 43.3 months and 10.5 months after curative surgery and palliative surgery respectively (χ2L = 31.10, P <0.01). Conclusion The overall prognosis of UGC is better than preoperative diagnosis of gallbladder malignancy, and should be actively re-radicalized as soon as possible. Early diagnosis and re-surgery to improve the prognosis of UGC patients.