【作者】 冯飞灵； 刘辰； 邱应和； 谭蔚锋； 张柏和； 姜小清；

【Author】 FENG Feiling,LIU Chen,QIU Yinghe,TAN Weifeng,ZHANG Baihe,JIANG Xiaoqing

【机构】 第二军医大学东方肝胆外科医院胆道一科；

【摘要】 目的探讨导致胆囊癌患者出现阻塞性黄疸的原因,及其相关的治疗分析。方法回顾性分析我院2004年1月-2008年12月的68例胆囊癌伴阻塞性黄疸的临床资料并进行随访。结果将胆囊癌导致阻塞性黄疸的原因分为3种:因肿瘤侵犯胆管导致黄疸、淋巴结转移压迫胆管导致黄疸、癌肿胆管内播散导致黄疸,分别为48例、12例和8例;平均生存时间为13.98±3.10月;4.18±1.13月和2.63±0.80月,生存时间存在显著差异(P<0.05);接受根治切除术(R0),分别为15例,0例和0例,根治率与黄疸原因成相关性(P<0.05)。肿瘤侵犯胆管导致黄疸组R0的生存时间23.96±5.83月,非R0的生存时间R0 5.84±1.50月,生存时间存在显著差异(P<0.05)。淋巴结转移压迫胆管导致黄疸组接受手术切除的患者生存时间6.00±2.16月、未接受手术切除的患者生存时间为3.25±1.28月,两者无显著差异(P>0.05)。结论胆囊癌伴阻塞性黄疸的患者预后较差,不同因素导致黄疸的患者的根治率明显不同,预后也不相同,尤其以淋巴结转移压迫胆管和癌肿胆管内播散导致黄疸的预后为差。胆囊癌伴阻塞性黄疸患者应当采取个体化的治疗方式,对于肿瘤压迫导致黄疸的患者应采取积极外科手术治疗,尽量达到镜下切缘阴性(R0);淋巴结转移压迫胆管的,但没有发现淋巴结广泛转移,可以考虑行手术切除;癌肿胆管内播散的,由于较早的出现远处脏器转移和广泛淋巴结转移,他们的治疗以减黄和肿瘤综合治疗为主。更多还原

【Abstract】 Objectives:The aim of the study was to explore the reasons which leads to obstructive jaundice related with therapeutic method in gallbladder carcinoma with obstructive jaundice. Methods:We retrospectively analyzed all patients with gallbladder cancer with obstructive jaundice who were treated at our institution between January 2004 to December 2008.Results: There were three reasons which lead to obstructive jaundice:Tumor involve bile duct、lymph node oppress bile duct and bile duct tumor throbus.The median survival time was 13.98±3.10 months, 4.18±1.13 months and 2.63±0.80 months,respectively.There was a statistical significance between these three groups(P<0.05).Conclusion:The gallbladder cancer with obstructive jaundice may be taken individual therapies,the patients whose bile duct was involved by tumor may be underwent curative resection;the patients whose bile duct was oppressed by lymph node but not achieved N2 may be underwent resection;the patients whose bile duct involved by tumor throbus may be treated with conservative.更多还原