Ouchi K, Suzuki M, Saijo S, Ito K, Matsuno S
First Department of Surgery, Tohoku University School of Medicine, Sendai, Japan.
Surgery. 1993 Mar;113(3):324-9.
To study the effect of recent advances in diagnosis and operative management on survival of patients with gallbladder carcinoma, records of 26 patients who underwent resection between 1960 and 1978 (group 1) and 25 patients who underwent resection between 1979 and 1991 (group 2) were compared. The operative mortality rate was lower in group 2 (0%) than in group 1 (12%). The 5-year survival rate was higher in group 2 (60.8%) than in group 1 (30.4%; p < 0.01). Although preoperatively undiagnosed cases were not less in group 2 than in group 1, cases diagnosed with certainty before surgery were increased significantly and suspected cases of gallbladder carcinoma were decreased in group 2 (p < 0.05) as a result of recent advances in hepatobiliary imaging techniques. Twenty patients in group 2 (80%) and 13 in group 1 (50%) had tumors less than 30 mm in diameter (p < 0.05). Nine patients in group 2 (36%) had tumors at an early stage (tumors limited to mucosal or muscular layer), and only two (8%) in group 1 had early-stage tumors (p < 0.05). The incidence of curative resection was higher in group 2 (76%) than in group 1 (27%; p < 0.001). Earlier diagnosis and a higher chance of curative resection, together with improved surgical techniques, may contribute to the better survival seen in the recent 12-year period.
为研究胆囊癌诊断和手术治疗的近期进展对患者生存的影响，比较了1960年至1978年间接受手术切除的26例患者（第1组）和1979年至1991年间接受手术切除的25例患者（第2组）的记录。第2组的手术死亡率（0%）低于第1组（12%）。第2组的5年生存率（60.8%）高于第1组（30.4%；p<0.01）。尽管第2组术前未确诊的病例并不比第1组少，但由于肝胆成像技术的近期进展，第2组术前确诊的病例显著增加，胆囊癌疑似病例减少（p<0.05）。第2组20例患者（80%）和第1组13例患者（50%）的肿瘤直径小于30mm（p<0.05）。第2组9例患者（36%）为早期肿瘤（肿瘤局限于黏膜或肌层），第1组仅2例（8%）为早期肿瘤（p<0.05）。第2组的根治性切除率（76%）高于第1组（27%；p<0.001）。更早的诊断、更高的根治性切除机会以及手术技术的改进，可能是近12年期间生存率提高的原因。
