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目的探讨意外胆囊癌的临床病理特点、外科治疗及预后。方法回顾性分析37例意外胆囊癌(IGC组)的临床资料,并与同期收治的89例其他胆囊癌(GC组)进行对比。结果与GC组相似,IGC组主要表现为右上腹痛(94.6%vs.93.3%),部分合并黄疸(16.2%vs.31.5%);IGC组与GC组在年龄[(56±12)岁vs.(57±9)岁],女性患者比例(78.4%vs.62.9%),CEA(25%vs.32.8%),CA19-9(30.0%vs.68.3%)阳性率,肿瘤分布部位,病理类型和分级,术后并发症发生率(2.7%vs.6.7%)均无统计学差异(均P>0.05),但其合并胆囊结石率(86.5%vs.50.6%)和早期(ⅠA期)病例比例(29.7%vs.9.0%)及手术切除率(56.8%vs.32.6%)均明显高于GC组(均P<0.05),晚期(Ⅲ,Ⅳ期)比例明显低于GC组(43.2%vs.74.2%,P=0.001)。IGC组的总体1,3,5年生存率(70.0%,31.2%,26.8%)及平均生存期和中位生存期[(51±13)个月,17个月]明显高于GC组(27.0%,17.7%,15.1%)[(25±8)个月,5个月](均P<0.01)。单因素生存分析结果显示TNM分期(P=0.000),T分期(P=0.000),手术方式(P=0.008)是显著影响IGC的预后因素,但是病理分级(P=0.080),年龄(P=0.188),性别(P=0.234)对预后无显著影响。COX多因素分析结果显示T分期(P=0.000)是影响IGC预后的独立因子。结论与GC相比,IGC合并胆囊结石率高,早期病例及切除率相对高,预后相对好;T分期是IGC的最显著的预后因子;除原位癌(Tis)及癌仅侵及黏膜层(T1a期)外,其他分期肿瘤,如首次手术漏诊,一律应尽早进行再次手术行根治性切除。
Objective To investigate the clinicopathological features, surgical treatment and prognosis of unexpected gallbladder cancer. Methods The clinical data of 37 cases of unexpected gallbladder cancer (IGC group) were retrospectively analyzed and compared with 89 cases of other gallbladder carcinomas (GC group) admitted in the same period. RESULTS: Similar to the GC group, the IGC group had right upper quadrant pain (94.6% vs 93.3%) and partial jaundice (16.2% vs.31.5% (57 ± 9) years old, the positive rate of female patients (78.4% vs.62.9%), CEA (25% vs.32.8%), CA19-9 (30.0% vs.68.3% There was no significant difference in the incidence of postoperative complications (2.7% vs.6.7%) (P> 0.05), but the incidence of gallstone (86.5% vs.50.6%) and early stage (29.7% vs.9.0%) and resection rate (56.8% vs.32.6%) were significantly higher than those in GC group (all P <0.05) vs 74.2%, P = 0.001). The overall 1,3,5-year overall survival (70.0%, 31.2%, 26.8%) and mean and median survival (51 ± 13 and 17 months) in the IGC group were significantly higher than those in the GC group 27.0%, 17.7%, 15.1%) [(25 ± 8) months, 5 months] (all P <0.01). The results of univariate survival analysis showed that the TNM stage (P = 0.000), T stage (P = 0.000) and surgical method (P = 0.008) were prognostic factors of IGC. However, the pathological grade 0.188), gender (P = 0.234) had no significant effect on prognosis. COX multivariate analysis showed that T stage (P = 0.000) was an independent factor affecting the prognosis of IGC. Conclusions Compared with GC, gallbladder with IGC has high rate of gallstone, early cases and resection rate is relatively high, the prognosis is relatively good; T staging is the most significant prognostic factor of IGC; except in situ carcinoma (Tis) and cancer invasion and mucosal layer (T1a), other staging tumors, such as the first surgery, missed diagnosis, should be the first radical resection of the surgical resection.