胰頭后淋巴結(jié)清掃在T3、T4期膽囊癌治療中的意義
發(fā)布時(shí)間：2019-04-26 05:00
【摘要】：研究目的通過(guò)回顧性調(diào)查T(mén)3、T4期膽囊癌臨床病理特征及膽囊癌患者的預(yù)后,并分析手術(shù)淋巴結(jié)清掃對(duì)于T3、T4期膽囊癌預(yù)后的影響,幫助確定進(jìn)行膽囊癌根治性手術(shù)時(shí)進(jìn)行淋巴結(jié)清掃的范圍,并為判斷膽囊癌患者的預(yù)后提供更多的參考。研究方法回顧性分析2009年1月至2013年12月間第二軍醫(yī)大學(xué)東方肝膽外科醫(yī)院收治的膽囊癌行手術(shù)治療且術(shù)后經(jīng)病理診斷證實(shí)病理分期處于T3、T4期的182例膽囊癌手術(shù)病例的臨床與隨訪資料。并將入組的患者根據(jù)手術(shù)切除的范圍和腫瘤的pT分期分為T(mén)3標(biāo)準(zhǔn)組、T3擴(kuò)大清掃組、T4標(biāo)準(zhǔn)組、T4擴(kuò)大清掃組、HPD組,分析淋巴結(jié)清掃范圍對(duì)膽囊癌患者預(yù)后的影響。生存分析采用Kaplan-Meier法,比較術(shù)后并發(fā)癥采用x2和Fisher確切概率法,以P0.05認(rèn)為差異有統(tǒng)計(jì)學(xué)意義。研究結(jié)果全組pT3期118例,pT4期64例。經(jīng)術(shù)后病理檢查發(fā)現(xiàn)手術(shù)切除的淋巴結(jié)中存在腫瘤轉(zhuǎn)移的146例,全組的淋巴結(jié)轉(zhuǎn)移率為80.2%(146/182)。其中,pT3期118例患者中89例存在區(qū)域淋巴結(jié)轉(zhuǎn)移,pT4期64例患者57例存在區(qū)域淋巴結(jié)轉(zhuǎn)移,淋巴結(jié)轉(zhuǎn)移率分別為75.4%、和89.1%。T3標(biāo)準(zhǔn)組共78例,中位生存時(shí)間11個(gè)月；T3擴(kuò)大清掃組共40例,中位生存時(shí)間30個(gè)月；T4標(biāo)準(zhǔn)組共39例,中位生存時(shí)間8個(gè)月；T4擴(kuò)大清掃組共19例,中位生存時(shí)間18個(gè)月；HPD組共6例,中位生存時(shí)間15個(gè)月。應(yīng)用Kaplan-Meier法對(duì)比T3標(biāo)準(zhǔn)組、T3擴(kuò)大清掃組；T4標(biāo)準(zhǔn)組、T4擴(kuò)大清掃組；T4擴(kuò)大清掃組、HPD組患者的術(shù)后生存時(shí)間發(fā)現(xiàn)。T3擴(kuò)大清掃組對(duì)比T3標(biāo)準(zhǔn)組術(shù)后生存時(shí)間存在差異,該結(jié)果有統(tǒng)計(jì)學(xué)意義(P0.01)。T4擴(kuò)大清掃組對(duì)比T4標(biāo)準(zhǔn)組術(shù)后生存時(shí)間存在差異,該結(jié)果有統(tǒng)計(jì)學(xué)意義(P0.01)；T4擴(kuò)大清掃組對(duì)比HPD組術(shù)后生存時(shí)間的差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.865)。入組患者均無(wú)圍手術(shù)期死亡病例。各組術(shù)后并發(fā)癥發(fā)生率為T(mén)3標(biāo)準(zhǔn)組14.1%(11/78),T3擴(kuò)大清掃組15.0%(6/40),T4標(biāo)準(zhǔn)組15.3%(6/39),T4擴(kuò)大清掃組15.8%(3/19),HPD組50%(3/6)。相互比較后發(fā)現(xiàn)差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。研究結(jié)論膽囊癌的淋巴結(jié)轉(zhuǎn)移與T3、T4期膽囊癌患者預(yù)后相關(guān)。在能進(jìn)行根治性手術(shù)的前提下,應(yīng)擴(kuò)大區(qū)域淋巴結(jié)的清掃范圍。
[Abstract]:Objective to investigate retrospectively the clinicopathological features and prognosis of patients with gallbladder carcinoma in stage T 3 and T 4, and to analyze the effect of surgical lymph node dissection on the prognosis of stage T 3 and T 4 gallbladder carcinoma, and analyze the effect of lymph node dissection on the prognosis of stage T 3 and T 4 gallbladder carcinoma. It is helpful to determine the range of lymph node dissection during radical operation of gallbladder carcinoma and provide more reference for predicting prognosis of patients with gallbladder cancer. Methods from January 2009 to December 2013, the patients with gallbladder cancer who received surgical treatment from January 2009 to December 2013 in Oriental hepatobiliary surgery Hospital, second military Medical University were treated surgically and the pathological stage was confirmed by pathological diagnosis to be at T3, Clinical and follow-up data of 182 cases of gallbladder carcinoma in T4 stage. The patients in the group were divided into T 3 standard group, T 4 extended dissection group and HPD group according to the scope of surgical resection and pT staging of tumor. The effects of lymph node dissection range on prognosis of gallbladder cancer patients were analyzed. Kaplan-Meier method was used for survival analysis and x2 and Fisher exact probability method were used to compare the postoperative complications. The difference was statistically significant (P0.05). Results there were 118 cases of pT3 stage and 64 cases of pT4 stage. Postoperative pathological examination showed that 146 cases had tumor metastasis in the resected lymph nodes. The lymph node metastasis rate in the whole group was 80.2% (146 / 182), and the lymph node metastasis rate in the whole group was 80.2% (146 / 182). Among them, 89 cases had regional lymph node metastasis in pT3 stage, 57 cases had regional lymph node metastasis in 64 cases of pT4 stage, the lymph node metastasis rate was 75.4% respectively, and 78 cases in 89.1%.T3 standard group. Median survival time was 11 months; The median survival time was 30 months in T 3 extended sweep group, 39 cases in T 4 standard group, 19 cases in T 4 extended clearance group, and 6 cases in HPD group, and the median survival time was 15 months in T 4 standard group, and 19 cases in T 4 extended sweep group, with a median survival time of 18 months and a median survival time of 8 months in T 4 standard group, and 6 cases in T 3 extended clearance group, respectively. Kaplan-Meier method was used to compare T3 standard group, T3 expanded cleaning group, T4 standard group, T4 expanded cleaning group. The postoperative survival time of patients with T 4 enlarged clearance and HPD group was found to be different compared with T 3 standard group, and the survival time of T 3 group was significantly higher than that of T 3 standard group. The results were statistically significant (P0.01). There was a significant difference in the survival time between the T4 standard group and the T4 standard group (P0.01), and there was a significant difference in the survival time between the T4 standard group and the T4 standard group. There was no significant difference in postoperative survival time between HPD group and T4 expanded cleaning group (P < 0. 865). No peri-operative death was found in all the patients in the group. The postoperative complications were 14.1% (11 / 78), 15.0% (6 / 40), 15.3% (6 / 39), 15.8% (3 / 19) and 15.8% (3 / 19) in T _ 3 standard group, T _ 3 expanded cleaning group, T _ 4 standard group and T _ 4 extended cleaning group, respectively. HPD group was 50% (3 / 6). Compared with each other, the differences were not statistically significant (P0.05). Conclusion lymph node metastasis of gallbladder carcinoma is associated with prognosis of patients with stage T 3 and T 4 gallbladder carcinoma. Under the premise of radical operation, the scope of regional lymph node dissection should be expanded.
【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R735.8
[Abstract]:Objective to investigate retrospectively the clinicopathological features and prognosis of patients with gallbladder carcinoma in stage T 3 and T 4, and to analyze the effect of surgical lymph node dissection on the prognosis of stage T 3 and T 4 gallbladder carcinoma, and analyze the effect of lymph node dissection on the prognosis of stage T 3 and T 4 gallbladder carcinoma. It is helpful to determine the range of lymph node dissection during radical operation of gallbladder carcinoma and provide more reference for predicting prognosis of patients with gallbladder cancer. Methods from January 2009 to December 2013, the patients with gallbladder cancer who received surgical treatment from January 2009 to December 2013 in Oriental hepatobiliary surgery Hospital, second military Medical University were treated surgically and the pathological stage was confirmed by pathological diagnosis to be at T3, Clinical and follow-up data of 182 cases of gallbladder carcinoma in T4 stage. The patients in the group were divided into T 3 standard group, T 4 extended dissection group and HPD group according to the scope of surgical resection and pT staging of tumor. The effects of lymph node dissection range on prognosis of gallbladder cancer patients were analyzed. Kaplan-Meier method was used for survival analysis and x2 and Fisher exact probability method were used to compare the postoperative complications. The difference was statistically significant (P0.05). Results there were 118 cases of pT3 stage and 64 cases of pT4 stage. Postoperative pathological examination showed that 146 cases had tumor metastasis in the resected lymph nodes. The lymph node metastasis rate in the whole group was 80.2% (146 / 182), and the lymph node metastasis rate in the whole group was 80.2% (146 / 182). Among them, 89 cases had regional lymph node metastasis in pT3 stage, 57 cases had regional lymph node metastasis in 64 cases of pT4 stage, the lymph node metastasis rate was 75.4% respectively, and 78 cases in 89.1%.T3 standard group. Median survival time was 11 months; The median survival time was 30 months in T 3 extended sweep group, 39 cases in T 4 standard group, 19 cases in T 4 extended clearance group, and 6 cases in HPD group, and the median survival time was 15 months in T 4 standard group, and 19 cases in T 4 extended sweep group, with a median survival time of 18 months and a median survival time of 8 months in T 4 standard group, and 6 cases in T 3 extended clearance group, respectively. Kaplan-Meier method was used to compare T3 standard group, T3 expanded cleaning group, T4 standard group, T4 expanded cleaning group. The postoperative survival time of patients with T 4 enlarged clearance and HPD group was found to be different compared with T 3 standard group, and the survival time of T 3 group was significantly higher than that of T 3 standard group. The results were statistically significant (P0.01). There was a significant difference in the survival time between the T4 standard group and the T4 standard group (P0.01), and there was a significant difference in the survival time between the T4 standard group and the T4 standard group. There was no significant difference in postoperative survival time between HPD group and T4 expanded cleaning group (P < 0. 865). No peri-operative death was found in all the patients in the group. The postoperative complications were 14.1% (11 / 78), 15.0% (6 / 40), 15.3% (6 / 39), 15.8% (3 / 19) and 15.8% (3 / 19) in T _ 3 standard group, T _ 3 expanded cleaning group, T _ 4 standard group and T _ 4 extended cleaning group, respectively. HPD group was 50% (3 / 6). Compared with each other, the differences were not statistically significant (P0.05). Conclusion lymph node metastasis of gallbladder carcinoma is associated with prognosis of patients with stage T 3 and T 4 gallbladder carcinoma. Under the premise of radical operation, the scope of regional lymph node dissection should be expanded.
【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R735.8
【共引文獻(xiàn)】
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