目的分析晚期胆囊癌(UICC III、IV期)的临床特点,总结外科治疗经验,探讨提高晚期胆囊癌生存率的方法。方法回顾性分析东方肝胆外科医院2002年01月至2012年12月收治的360例晚期胆囊癌的患者资料。Kaplan-Meier法绘制生存曲线,单因素分析采用Log-rank检验,多因素采用COX回归模型。结果 360例中312例得到有效随访,中位随访时间为42.0个月,中位生存时间为17.6个月。1、3、5年生存率分别为68.0%、30.7%及15.4%。单因素分析结果:术前黄疸、手术方式、意外胆囊癌、肿瘤位置、肝外胆管切除、手术切缘、肝侵犯、病理学分级、T分期、N分期、M分期均是影响患者预后的危险因素。多因素分析结果:N分期、病理学分级、肝侵犯、手术切缘、手术方式均是影响患者预后的独立危险因素。结论晚期胆囊癌预后差,积极的外科手术可改善患者预后。N分期、病理学分级、肝侵犯、手术切缘、手术方式均是晚期胆囊癌外科治疗预后不良的独立危险因素。 Objective To analyze the clinical features of advanced gallbladder cancer (UICC III and IV) and summarize the experience of surgical treatment to explore ways to improve the survival rate of advanced gallbladder cancer. Methods The data of 360 patients with advanced gallbladder carcinoma admitted from January 2002 to December 2012 in Eastern Hepatobiliary Surgery Hospital were retrospectively analyzed. Kaplan-Meier survival curves were drawn, univariate analysis using Log-rank test, multi-factor using COX regression model. Results Among 360 cases, 312 cases were effectively followed up. The median follow-up time was 42.0 months and the median survival time was 17.6 months. The 1, 3, 5-year survival rates were 68.0%, 30.7% and 15.4% respectively. Univariate analysis showed that preoperative jaundice, surgical procedure, unexpected gallbladder cancer, tumor location, extrahepatic bile duct excision, surgical margin, liver invasion, pathological grade, T stage, N stage and M stage were the risk factors affecting the prognosis factor. Multivariate analysis of the results: N staging, pathological grade, liver invasion, surgical margin, surgical methods are independent prognostic risk factors. Conclusions The prognosis of advanced gallbladder carcinoma is poor. Positive surgery can improve the prognosis of patients. N staging, pathological grade, liver invasion, surgical margin, surgical approach are independent prognostic factors of advanced gallbladder surgery.