中段胆管癌：胆管节段切除术是否合适？
Carcinoma of the middle bile duct: is bile duct segmental resection appropriate?
机构信息
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, South Korea.
出版信息
World J Gastroenterol. 2009 Dec 21;15(47):5966-71. doi: 10.3748/wjg.15.5966.
AIM
To compare survival between bile duct segmental resection (BDSR) and pancreaticoduodenectomy (PD) for treating distal bile duct cancers.
METHODS
Retrospective analysis was conducted for 45 patients in a BDSR group and for 149 patients in a PD group.
RESULTS
The T-stage (P < 0.001), lymph node invasion (P = 0.010) and tumor differentiation (P = 0.005) were significant prognostic factors in the BDSR group. The 3- and 5-year overall survival rates for the BDSR group and PD group were 51.7% and 36.6%, respectively and 46.0% and 38.1%, respectively (P = 0.099). The BDSR group and PD group did not show any significant difference in survival when this was adjusted for the TNM stage. The 3- and 5-year survival rates were: stage Ia [BDSR (100.0% and 100.0%) vs PD (76.9% and 68.4%) (P = 0.226)]; stage Ib [BDSR (55.8% and 32.6%) vs PD (59.3% and 59.3%) (P = 0.942)]; stage IIb [BDSR (19.2% and 19.2%) vs PD (31.9% and 14.2%) (P = 0.669)].
CONCLUSION
BDSR can be justified as an alternative radical operation for patients with middle bile duct in selected patients with no adjacent organ invasion and resection margin is negative.
目的
比较胆管节段切除术（BDSR）和胰十二指肠切除术（PD）治疗远端胆管癌的生存情况。
方法
回顾性分析 45 例 BDSR 组和 149 例 PD 组患者。
结果
BDSR 组的 T 分期（P<0.001）、淋巴结侵犯（P=0.010）和肿瘤分化（P=0.005）是显著的预后因素。BDSR 组和 PD 组的 3 年和 5 年总生存率分别为 51.7%和 36.6%，46.0%和 38.1%（P=0.099）。当按 TNM 分期调整时，BDSR 组和 PD 组的生存无显著差异。3 年和 5 年生存率为：Ia 期[BDSR（100.0%和 100.0%）vs PD（76.9%和 68.4%）（P=0.226）]；Ib 期[BDSR（55.8%和 32.6%）vs PD（59.3%和 59.3%）（P=0.942）]；IIb 期[BDSR（19.2%和 19.2%）vs PD（31.9%和 14.2%）（P=0.669）]。
结论
BDSR 可作为一种选择性根治性手术方法，适用于无邻近器官侵犯且切缘阴性的中胆管癌患者。
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