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目的本研究通过对胆囊癌的临床病理特征、影响预后的因素及相互关系的分析,为胆囊癌的诊断、治疗及预后评价提供参考。方法回顾性分析第二军医大学附属东方肝胆外科医院2003年12月至2009年12月收治的169例胆囊癌患者的临床资料,选择了14个可能对胆囊癌患者预后产生影响的临床及病理学因素,采用Kplan-Meier分析对确定的单因素进行生存率的描述,用Cox回归进行多因素分析。结果 Kplan-Meier单因素生存分析显示,根治性手术切除、淋巴结转移、TNM分期、肿瘤在胆囊中位置(颈、体、底部)、组织学分化、术中失血、术前黄疸为影响胆囊癌预后的因素(P<0.05);进一步用多因素Cox回归分析表明,根治性切除、淋巴结转移、肿瘤在胆囊中位置是影响胆囊癌预后的独立危险因素,相对风险度分别为1.841、1.852、0.568(P=0.003、0.002、0.002)。结论胆囊癌是胆道系统较常见的恶性肿瘤,恶性程度高,此项研究发现根治性切除、淋巴结转移、肿瘤位于胆囊颈部为胆囊癌切除术后影响预后的独立危险因素。因此,早期诊断和根治性手术切除仍是胆囊癌唯一有效的治疗方法。此外,黄疸是影响胆囊癌患者预后的不良因素,但是若选择合适的病例,存在黄疸并不是手术切除的绝对禁忌证(当总切除是可以实现R0)。
Objective This study provides a reference for the diagnosis, treatment and prognosis evaluation of gallbladder cancer by analyzing the clinicopathological features, the factors affecting the prognosis of gallbladder cancer and the correlation between them. Methods The clinical data of 169 patients with gallbladder carcinoma admitted from December 2003 to December 2009 at the Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University were retrospectively analyzed. The clinical and pathological features of 14 patients with gallbladder carcinoma were selected for their prognosis Factors, using a Kplan-Meier analysis of the described single-factor survival rate was described by Cox regression multivariate analysis. Results Kplan-Meier univariate survival analysis showed that radical surgery, lymph node metastasis, TNM staging, tumor location in the gallbladder (neck, body, bottom), histological differentiation, intraoperative blood loss, preoperative jaundice affect the prognosis of gallbladder cancer (P <0.05). Further multivariate Cox regression analysis showed that radical resection, lymph node metastasis and tumor location in the gallbladder were independent risk factors for the prognosis of gallbladder cancer. The relative risk were 1.841,1.852,0.568 P = 0.003, 0.002, 0.002). Conclusions Gallbladder carcinoma is a common malignant tumor of the biliary tract and has a high degree of malignancy. This study found that radical resection, lymph node metastasis and tumor at the gallbladder neck were independent risk factors for prognosis after gallbladder resection. Therefore, the early diagnosis and radical surgery is still the only effective treatment of gallbladder cancer. In addition, jaundice is an adverse factor affecting the prognosis of patients with gallbladder cancer, but the presence of jaundice is not an absolute contraindication for surgical resection (when total resection is R0).