胆囊癌腹主动脉旁淋巴结转移患者的临床病理特征

摘要

Objective To study the clinical course and clinicopathological features of para-aortic lymph node metastases in patients with gallbladder cancer.Methods Forty-two patients with gallbladder cancer who underwent radical resection combined with para-aortic lymphadenectomy at the Mianyang Hospital of Traditional Chinese Medicine from January 2001 to December 2013 were retrospectively studied.The survival rates of the para-aortic lymph node metastasis group were compared with the negative para-aortic lymph node group of patients.Para-aortic lymph node metastasis as well as clinical features were correlated with survival.Results No one died within the perioperative period.The total complication rate was 24.0％,and there was no significant difference between the positive para-aortic lymph node group and the negative group (P ＞0.05).The rate of para-aortic lymph node metastasis on histopathology was 21.4％ (9/42),which was positively correlated with tumor depth of invasion and negatively correlated with the degree of differentiation (P ＜ 0.01).The 1-,2-,and 3-year survival rates of the positive para-aortic lymph node group were significantly inferior to the negative group (P ＜ 0.05).Conclusions Dissection of para-aortic lymph nodes in patients with gallbladder cancer was safe and feasible.Lymphadenectomy did not improve the longterm survival rates of patients with para-aortic lymph node involvement metastases.The extent of lymph node dissection for gallbladder cancer should be decided by intraoperative biopsy.%目的 探讨胆囊癌腹主动脉旁淋巴结转移规律及与临床病理特征的关系.方法 回顾性分析绵阳市中医医院普外科2001年1月-2013年12月施行的包括腹主动脉旁淋巴结廓清术在内的42例胆囊癌根治术患者的临床资料.比较腹主动脉旁淋巴结阳性与阴性患者的生存率,观察腹主动脉旁淋巴结转移与临床特征的相关性.结果 所有患者未发生围手术期死亡.42例患者总并发症发生率为24.0％.腹主动脉旁淋巴结阴性组与阳性组并发症发生率差异无统计学意义(P＞0.05).术后病理证实腹主动脉旁淋巴结转移率为21.4％ (9/42).腹主动脉旁淋巴结转移率随肿瘤浸润深度的增加和分化程度降低而升高(P＜0.01).腹主动脉旁淋巴结阳性患者1、2、3年生存率均显著低于阴性患者(均P＜0.05).结论 胆囊癌腹主动脉旁淋巴结廓清安全可行,但未能提高腹主动脉旁淋巴结转移患者的长期生存状况.临床应根据术中快速病理检查结果确定淋巴结清扫方案.