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目的:探讨扩大淋巴结清扫对T_3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(χ~2=45.921,P<0.05)。结论:T_3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。
Objective: To investigate the effect of expanding lymph node dissection on the prognosis of T_3 gallbladder cancer patients. Methods: The clinical data of 45 patients with T3 gallbladder carcinoma undergoing gallbladder radical resection from January 2009 to December 2014 were retrospectively analyzed. According to the range of lymph node dissection, the patients were divided into two groups: standard dissection group (n = 20, standard lymph node dissection, lymph node dissection around the common bile duct and hepatoduodenal ligament) and enlarged dissection group Expand the regional lymph node dissection, that is, based on the standard lymph node dissection, pancreatic head lymph node dissection, and sent to the rapid pathological examination, if positive plus abdominal para-aortic lymph node dissection. Postoperative complications and prognosis were compared between the two groups. Results: There was no perioperative death in both groups. The incidence of complication in the standard cleaning group was 15.0% (3/20), and the complication rate in the expanding cleaning group was 20.0% (5/25), with no significant difference (P> 0.05). The standard 1-year and 3-year cumulative survival rates were 8% and 0, respectively. The median survival time was 9 months. In the extended-scan group, the 1- and 3-year cumulative survival rates were 100% and 44%, respectively. The median survival time was 28 months , And the survival rate was significantly higher in the extended cleaning group than in the standard cleaning group (χ ~ 2 = 45.921, P <0.05). Conclusions: On the basis of radical resection of primary lesions in patients with T_3 gallbladder carcinoma, postoperative survival rate can be significantly improved by using extended lymph node dissection, which focuses on the dissection of the upper and lower abdominal aorta nodes after dissection. Do not increase the surgical complications.