专题研究(Monographic Study)

T3期胆囊癌行扩大淋巴结清扫的临床效果

Published at: 2017年第26卷第8期

周红兵 1 , 杨兴业 1 , 陈曦 1 , 袁寅 1
1 江苏省泰州市人民医院 肝胆外科,江苏 泰州 225300
通讯作者 红兵 周 Email: 327543501@qq.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2017.08.003
基金:

摘要

目的:探讨扩大淋巴结清扫对T3期胆囊癌患者预后的影响。方法:回顾性分析2009年1月—2014年12月江苏省泰州市人民医院45例行胆囊癌根治术的T3期胆囊癌患者的临床资料。根据术中淋巴结清扫范围分为标准清扫组(20例,行标准区域淋巴结清扫,即清扫胆囊管、胆总管周围及肝十二指肠韧带等部位的淋巴结)和扩大清扫组(25例,行扩大区域淋巴结清扫,即标准淋巴结清扫基础上,行胰头后上淋巴结清扫,并送快速病理检查,如为阳性则加做腹主动脉旁淋巴结清扫)。比较两组患者术后并发症情况及预后。结果:两组患者均无围手术期死亡。标准清扫组患者并发症发生率为15.0%(3/20),扩大清扫组患者并发症发生率为20.0%(5/25),差异无统计学意义(P>0.05)。标准清扫组1、3年累积生存率为8%、0,中位生存时间为9个月;扩大清扫组1、3年累积生存率为100%、44%,中位生存时间为28个月,扩大清扫组生存率明显高于标准清扫组(χ2=45.921,P<0.05)。结论:T3期胆囊癌患者在原发病灶能够根治性切除的基础上,加行以清扫胰头后上方淋巴结及腹主动脉旁淋巴结为重点的扩大淋巴结清扫可明显提高患者术后生存率,且不增加手术并发症。


Clinical efficacy of extended lymphadenectomy in treatment of T3 gallbladder cancer

Abstract

Objective: To investigate the impact of extended lymph node dissection on patients with T3 gallbladder cancer. Methods: The clinical data of 45 patients with T3 gallbladder cancer undergoing radical surgery in Taizhou People’s Hospital from January 2009 to December 2014 were retrospectively analyzed. According to the scope of lymphadenectomy, the patients were divided into standard dissection group (20 cases undergoing standard regional lymphadenectomy, namely, dissection of the lymph nodes around the cystic duct and common bile duct and hepatoduodenal ligament), and extended dissection group (25 patients undergoing extended regional lymphadenectomy, namely, standard regional lymphadenectomy plus lymphadenectomy of the posterior superior region of the head of the pancreas, or additional para-aortic lymphadenectomy for those with positive finding in rapid pathological diagnosis). The incidence of postoperative complications and survival conditions of two groups of patients were compared. Results: No perioperative death occurred in any of the groups. The incidence of postoperative complications was 15% (3/20) in standard dissection group and 20% (5/25) in extended dissection group, which showed no statistical difference (P>0.05). The 1- and 3-year cumulative survival rate and median survival time was 8%, 0 and 9 months in standard dissection group, and 100%, 44% and 28 months in extended dissection group, and the survival rate in extended dissection group was significantly higher than that in standard dissection group (χ2=45.921, P<0.05). Conclusion: The extended regional lymphadenectomy focusing on lymph nodes in the posterior superior region of the head of the pancreas and para-aortic lymph nodes may effectively improve the survival of the patients with T3 gallbladder cancer without an increase of surgical complications under the premise of radical resection of the primary lesion.


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引用

引用本文: 红兵 周, 兴业 杨, 曦 陈, 寅 袁. T3期胆囊癌行扩大淋巴结清扫的临床效果 [J]. 中国普通外科杂志, 2017, 26(8): 968-972.
Cite this article as: ZHOU Hongbing, YANG Xingye, CHENG Xi, YUAN Yin . Clinical efficacy of extended lymphadenectomy in treatment of T3 gallbladder cancer [J]. Chin J Gen Surg, 2017, 26(8): 968-972.