单中心肝胆胰外科 10 年胆囊癌诊治经验并文献复习
Ten-year experience in the management of gallbladder cancer from a single hepatobiliary and pancreatic centre with review of the literature.
机构信息
Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK.
出版信息
HPB (Oxford). 2008;10(6):446-58. doi: 10.1080/13651820802392346.
BACKGROUND
There is no consensus regarding the optimum surgical approach to gallbladder cancer. This study reviews the management of gallbladder cancer in a single unit.
METHODS
Retrospective study of 73 consecutive patients diagnosed with gallbladder cancer. Twenty-three patients underwent surgery with curative intent (surgical group), 28 patients underwent exploratory surgery but had inoperable disease (surgically inoperable group) and 22 patients had inoperable disease radiologically (radiologically inoperable group). Within the surgical group, nine patients (cholecystectomy group) were diagnosed with gallbladder cancer after routine cholecystectomy.
RESULTS
The inoperable groups had significantly higher bilirubin and alkaline phosphatase (ALP) than the surgical group (p=0.02 and p<0.01, respectively). Age>68, white cell count (WCC)>7.6 x 109/L, platelet>345 x 109/L, bilirubin>16 mol/L, ALP >124 iu/L and sodium < or = 137 mmol/L were markers of inoperability. Age, haemoglobin and neutrophil:lymphocyte ratio (NLR) were predictors for survival following surgery (p=0.04, p=0.01 and p<0.01, respectively). The surgical and cholecystectomy groups had significantly higher median survivals than the surgically and radiologically inoperable groups (18.97 and 26.17 months versus 5.03 and 12.20 months, p=0.04).
CONCLUSION
Curative surgical resection of gallbladder cancer improved survival. Exploratory laparotomy which revealed inoperable disease reduced survival. Preoperative WCC, platelet, bilirubin and ALP may be used as additional discriminators during the investigation and work up prior to surgery.
背景
对于胆囊癌的最佳手术方法尚无共识。本研究回顾了单一单位的胆囊癌治疗方法。
方法
对 73 例连续诊断为胆囊癌的患者进行回顾性研究。23 例患者接受了有治愈意图的手术（手术组），28 例患者接受了探查性手术但患有不可切除的疾病（手术不可切除组），22 例患者在影像学上患有不可切除的疾病（影像学不可切除组）。在手术组中，9 例患者（胆囊切除术组）在常规胆囊切除术后被诊断为胆囊癌。
结果
不可切除组的胆红素和碱性磷酸酶（ALP）明显高于手术组（p=0.02 和 p<0.01）。年龄>68 岁、白细胞计数（WCC）>7.6 x 109/L、血小板>345 x 109/L、胆红素>16 mol/L、ALP >124 iu/L 和钠<或=137 mmol/L 是不可切除的标志物。年龄、血红蛋白和中性粒细胞：淋巴细胞比值（NLR）是手术后生存的预测因素（p=0.04、p=0.01 和 p<0.01）。手术组和胆囊切除术组的中位生存期明显长于手术组和影像学不可切除组（18.97 个月和 26.17 个月与 5.03 个月和 12.20 个月，p=0.04）。
结论
胆囊癌的根治性手术切除可提高生存率。揭示不可切除疾病的剖腹探查术降低了生存率。术前 WCC、血小板、胆红素和 ALP 可在手术前的检查和准备期间用作额外的鉴别指标。
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