원발성 담낭암 132예의 임상적 고찰

Abstract

Background: In spite of the development of diagnostic tools, gallbladder carcinoma is often diagnosed at a late stage because of the lack of symptomatic awareness of patients in early stage. Early diagnosis and proper resectional treatment is,therefore, the most important factor for the prognosis. This study aims at the analysis of clinical characteristics and the effect of various modes of surgical treatment on long-term survival. Methods: From January 1989 to December 1997 we operated on 132 patients with gallbladder carcinoma. Age, sex, stage distribution, clinical manifestations and mode of operations were analyzed.The cumulative survival rates were also analyzed for 107 patients who had been finally followed up,and the significance of survival difference was tested (p<0.05). Results: The average age of 132 patients was 64 years old, and female patients suffered more frequent incidence than male patients by a ratio of 1.7:1. The distribution of patients according to the pathologic TNM staging showed early stage (stage 0 &I)accounted for only 9.8% whereas the advanced stages (stageⅡ,Ⅲ,Ⅳa,Ⅳb)accounted for the majority of the patients (90.2%). The chief complaints were abdominal pain (84.8%), indigestion,weight loss,palpable mass and so forth in a decreasing frequency order. Among the patients, 30 cases (22.7%)were irresectable, 50 cases (38%)were curative resected, and 52 cases (39%)were palliative resected. The overall cumulative survival rates of 107 patients were 53.7%, 41.7%and 30.1%for 1-year, 2-year and 5-year survival respectively.Although the 5-year survival rate of curative resected patients showed a significantly better survival rate (p<0.005) than that of non-curative resected patients,the different modes of combined radical surgery did not affect the survival rates. Conclusion: Combined curative resection ameliorated long-term survival of patients with gallbladder carcinoma. For the further evaluation of the efficacy of combined radical surgery on survival,more extensive data needs to be accumulated.