基于肿瘤扩散的 T2 期胆囊癌的合理治疗策略。
Rational therapeutic strategy for T2 gallbladder carcinoma based on tumor spread.
机构信息
Department of Surgery, Saga University Faculty of Medicine, 5-1-1 Nabeshima, Saga 849-8501, Japan.
出版信息
World J Gastroenterol. 2010 Jul 28;16(28):3567-72. doi: 10.3748/wjg.v16.i28.3567.
AIM
To evaluate the adequacy of surgical treatment of T2 gallbladder carcinoma (GBCa) according to tumor spread in the subserosal layer.
METHODS
A series of 84 patients with GBCa were treated at Saga University Hospital, Japan between April 1989 and October 2008. The tumor stage was graded according to the TNM staging for GBCa from the American Joint Committee on Cancer Manual 6th edition. Tumor staging revealed 30 patients with T2 tumors. T2 GBCa was divided into three groups histologically by the extent of tumor spread in the subserosal layer, using a score of ss minimum (ss min), ss medium (ss med) or ss massive (ss mas).
RESULTS
For ss min GBCa, there was no positive pathological factor and patient survival was satisfactory with simple cholecystectomy, with or without extra-hepatic bile duct resection. For ss med GBCa, some pathological factors, h-inf (hepatic infiltration), ly (lymphatic invasion) and n (lymph node metastasis), were positive. For ss mas GBCa, there was a high incidence of positive pathological factors. The patient group with extra-hepatic bile duct resection with D2 lymph node dissection (BDR with D2) and those with S4a5 hepatectomy had significantly better survival rates.
CONCLUSION
We suggest that radical surgery is not necessary for ss min GBCa, and partial hepatectomy and BDR are necessary for both ss med and ss mas GBCa.
目的
评估根据胆囊壁固有层肿瘤扩散程度对 T2 期胆囊癌（GBCa）进行手术治疗的充分性。
方法
日本佐贺大学医院于 1989 年 4 月至 2008 年 10 月期间对 84 例 GBCa 患者进行了治疗。肿瘤分期根据美国癌症联合委员会手册第 6 版的 GBCa 的 TNM 分期进行分级。肿瘤分期显示 30 例患者为 T2 肿瘤。通过固有层肿瘤扩散程度的组织学，将 T2 GBCa 分为三组，使用 ss 最小（ss min）、ss 中等（ss med）或 ss 大量（ss mas）评分。
结果
对于 ss min GBCa，无阳性病理因素，单纯胆囊切除术，无论是否行肝外胆管切除术，患者生存均满意。对于 ss med GBCa，存在一些阳性病理因素，如 h-inf（肝浸润）、ly（淋巴侵犯）和 n（淋巴结转移）。对于 ss mas GBCa，阳性病理因素的发生率较高。行肝外胆管切除术加 D2 淋巴结清扫术（BDR 加 D2）和行 S4a5 肝切除术的患者生存明显较好。
结论
我们认为，对于 ss min GBCa，不需要根治性手术，而对于 ss med 和 ss mas GBCa，部分肝切除术和 BDR 是必要的。
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