本文選題：意外膽囊癌 + 臨床特征��； 參考：《浙江大學》2015年博士論文

【摘要】：目的：在膽道系統(tǒng)惡性腫瘤之中,膽囊癌的發(fā)病率最高。膽囊癌病人是否能長期生存的重要預后因素是診斷時疾病已經發(fā)展到哪一階段以及是否能完整切除。近年來,隨著腹腔鏡膽囊手術的普及,特別是“意外膽囊癌”的現象得到重視。納入本中心意外膽囊癌病例,進行意外膽囊癌病例臨床特征分析,描繪意外膽囊癌病人臨床特征圖譜,更進一步進行意外膽囊癌病人生存分析,以期得出有一定臨床價值的結果。 方法：納入本中心意外膽囊癌病人,記錄患者基本信息(包括手術時的年齡、患者性別、主訴、臨床診斷),影像學檢查結果,手術方式,術后病理結果及分期,臨床結局(包括住院日、死亡時間、最后隨訪時間、輔助治療等)等,使用Kaplan-Meier方法建立生存曲線,Log-rank方法進行比較。單因素的生存分析使用單因素COX回歸方法。進一步多因素分析使用多因素COX回歸模型,所有分析P0.05為顯著。 結果：一共有40名病理結果為膽囊腺癌的意外膽囊癌病人納入本研究(33名女性/7名男性,年齡中位數為58歲)。切除膽囊的病理報告結果顯示有24名病人原發(fā)腫瘤浸潤程度為T2,術中確診膽囊癌的為11例,行膽囊癌根治手術的病人共21例。T2期及以上等級的意外膽囊癌病人,1年生存率為69.4%,3年生存率為59.3%。Ⅱ期、Ⅲ期、ⅣV期病人1年生存率分別為76.7%、49%和0%(P0.05)。T2期的病人行根治術與未行根治術病人3年生存率分別為71.1%和58.3%(P0.05)。T3期的病人行根治術與未行根治術病人1年生存率分別為50%和66.7%(P0.05)。淋巴結轉移病人術后生存期顯著低于無淋巴結轉移病人(RR=0.160,95%CI為0.027-0.946,P=0.043)。發(fā)生遠處轉移病人術后生存期顯著低于無遠處轉移的病人(RR=0.124,95%CI為0.020-0.749,P=0.023)。 總結：Ⅱ、Ⅲ、Ⅳ期意外膽囊癌病人預后顯著不同,隨分級越高,1年生存率顯著下降(P0.05)。Tlb、T2及T3期無遠處轉移的意外膽囊癌病人是否行根治術,對其術后長期生存無顯著影響(P0.05)。在多因素分析中,淋巴結轉移和遠處轉移是獨立的影響意外膽囊癌病人術后生存的顯著因素,使得生存率顯著下降(P0.05)。
[Abstract]:Objective: among the malignant tumors of the biliary system, the incidence of gallbladder carcinoma is the highest. An important prognostic factor for long-term survival in patients with gallbladder cancer is the stage at which the disease has been diagnosed and whether it can be removed completely. In recent years, with the popularization of laparoscopic cholecystectomy, especially the phenomenon of "accidental gallbladder carcinoma" has been paid attention to. The clinical features of patients with accidental gallbladder carcinoma were analyzed, and the clinical characteristics of patients with accidental gallbladder carcinoma were analyzed. The survival analysis of patients with accidental gallbladder carcinoma was further carried out. With a view to a certain clinical value of the results. Methods: the patients with accidental gallbladder cancer were included in this study. The basic information of the patients was recorded (including age at the time of operation, sex of the patients, main complaint, clinical diagnosis, imaging examination, operative method, postoperative pathological results and stages). Clinical outcomes (including hospitalization date, death time, last follow-up time, adjuvant therapy, etc.) were compared using Kaplan-Meier method to establish survival curve and Log-rank method. Univariate COX regression was used for survival analysis. Multivariate COX regression model was used in further multivariate analysis, all of which were significant (P0.05). Results: a total of 40 patients with accidental gallbladder carcinoma with pathological findings of gallbladder carcinoma were enrolled in this study, 33 women / 7 men with median age of 58 years. The pathological results of cholecystectomy showed that the primary tumor invasion was T _ 2 in 24 patients, and 11 cases were diagnosed as gallbladder carcinoma during the operation. There were 21 cases of accidental gallbladder carcinoma with grade T 2 and above. The 1 year survival rate was 69.4, and the 3 year survival rate was 59.3%. The 1-year survival rate of patients with stage 鈪，

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