Chijiiwa K, Tanaka M
Department of Surgery 1, Kyushu Univeristy Faculty of Medicine, Fukuoka, Japan.
Surgery. 1994 Jun;115(6):751-6.
After the development of hepatobiliary imaging modalities and surgical procedures, we reappraised the effect of surgical treatment on the prognosis of gallbladder carcinoma.
Records of 32 patients with gallbladder carcinoma who underwent surgical resection between 1982 and 1992 were examined according to the pTNM staging system, and patients' prognoses were analyzed in relation to pathologic staging and surgical procedures.
The standard operative procedure was extended cholecystectomy (cholecystectomy plus hepatic resection [wedge or anatomic segmentectomy] plus en bloc lymph node dissection) with or without extrahepatic bile duct resection, and this was performed in 63% of cases. The actual 5-year survival rate of patients whose postoperative period was more than 5 years was 53%. The standard operative procedure gave satisfactory results for nine patients with stage I or II disease because all except two patients who died of other diseases were still alive more than 3 years after operation and there were five (56%) 5-year survivors. At stage III with pN1a lymph node metastasis, 50% of patients survived more than 5 years. However, in patients with pN1b or distant organ metastases, none survived more than 3 years even after more aggressive operation including hepatectomy plus pancreatoduodenectomy.
Complete removal of microscopic spread to the liver, bile duct, and lymph nodes is a great advantage to patients with gallbladder carcinoma at stages I and II and to those at stage III even in the presence of lymph node metastasis in the hepatoduodenal ligament.
随着肝胆成像技术和外科手术的发展，我们重新评估了手术治疗对胆囊癌预后的影响。
根据pTNM分期系统，对1982年至1992年间接受手术切除的32例胆囊癌患者的记录进行检查，并分析患者的预后与病理分期和手术方式的关系。
标准手术方式为扩大胆囊切除术（胆囊切除术加肝切除术[楔形或解剖性节段切除术]加整块淋巴结清扫术），可伴或不伴肝外胆管切除术，63%的病例采用此术式。术后超过5年的患者实际5年生存率为53%。标准手术方式对9例I期或II期疾病患者取得了满意的效果，因为除2例死于其他疾病的患者外，所有患者术后3年以上仍存活，有5例（56%）5年生存率。在伴有pN1a淋巴结转移的III期患者中，50%的患者存活超过5年。然而，在伴有pN1b或远处器官转移的患者中，即使接受包括肝切除术加胰十二指肠切除术在内的更积极手术，也无患者存活超过3年。
对于I期和II期胆囊癌患者以及III期胆囊癌患者，即使存在肝十二指肠韧带淋巴结转移，彻底清除肝脏、胆管和淋巴结的微小转移灶对患者极为有利。
