中国实用外科杂志

中国实用外科杂志 ›› 2024, Vol. 44 ›› Issue (09): 1068-1074.DOI: 10.19538/j.cjps.issn1005-2208.2024.09.17

• 论著 • 上一篇    下一篇

局部进展期胆囊癌转化手术的安全性及有效性分析：一项单中心回顾性研究

张    宇1a，2，宋晓玲1a，2，杨春弘3，朱逸荻1a，2，李怀峰1a，2，杨自逸1a，2，吴自友2，陈素芸1b，周    晴1c，任    刚1d，沈    伟1e，李茂岚4，全志伟1a，2，刘颖斌4，管雯斌1f，吴向嵩1a，2，龚    伟1a，2   

  1. 1上海交通大学医学院附属新华医院 a.普外科 b.核医学科 c.肿瘤科 d. 医学影像科 e. 肛肠外科 f.病理科，上海 200092；2上海市胆道疾病研究中心 上海市胆道疾病研究重点实验室 上海交通大学医学院胆道疾病研究所，上海 200092；3上海交通大学医学院附属新华医院科研中心，上海 200092；4上海交通大学医学院附属仁济医院胆胰外科，上海 200127
  • 出版日期:2024-09-01 发布日期:2024-09-20

  • Online:2024-09-01 Published:2024-09-20

摘要： 目的    评估局部进展期胆囊癌转化手术的围手术期安全性及有效性。方法    回顾性分析上海交通大学医学院附属新华医院2020年1月至2023年12月的11例接受转化治疗的局部进展期胆囊癌病人的临床资料，分析转化手术的围手术期安全性和有效性。结果    11例病人均为上海交通大学医学院附属新华医院胆道肿瘤多学科综合治疗协作组团队评估为局部进展期胆囊癌病人。术前转化治疗中位周期为3（2~4）个周期，Ⅲ级以上转化治疗毒副反应发生率为27.3%。手术时间为363.0（300.0~415.0）min，术中出血量为400（200~500）mL，术中需要输血7例。11例病人中，无二次手术病人、无围手术期死亡病人、无Clavien-Dindo 3级以上并发症，6例病人术后出现Ⅱ级并发症：5例病人发生贫血，1例病人发生肺部感染，2例病人发生胸腔积液，2例病人发生胃排空障碍。术后住院时间为15（11~33）d。11例病人均为R0切除，手术清扫淋巴结中位数目为14（9~19）枚。8例病人实现降期，术后中位随访时间为9（6~19）个月，截至末次随访，4例病人出现复发，中位无进展生存期为8.0个月（95%CI 4.06~21.94）。结论    转化手术对于局部进展期胆囊癌病人具有良好的围手术期安全性，给病人提供了R0切除的手术机会，早期预后良好，值得进一步深入研究探索。

关键词: 胆囊癌, 局部进展期, 转化治疗, 转化手术

Abstract: To evaluate the perioperative safety and efficacy of conversion surgery for locally advanced gallbladder cancer. Methods    Clinical records of 11 patients with locally advanced gallbladder cancer who received conversion surgery from January 2020 to December 2023 at Xinhua Hospital, Shanghai Jiaotong University School of Medicine were retrospectively collected. The perioperative safety and efficacy of conversion surgery for these patients were analysed. Results    All 11 patients were categorized as locally advanced gallbladder cancer after evaluation by our Biliary Tumor Multidisciplinary team. The median number of cycles of preoperative conversion therapy was 3 (interquartile range: 2-4), and the incidence of grade Ⅲ or higher treatment-related adverse events was 27.3%. The operation time was 363.0 (interquartile range: 300.0-415.0) min, intraoperative blood loss was 400 (interquartile range: 200-500) mL, and 7 patients received intraoperative blood transfusion. Postoperatively, there was no incidence of re-operation, mortality, or grade Ⅲ or higher Clavien-Dindo complications. Six patients developed grade Ⅱ Clavien-Dindo complications including 5 cases of postoperative anemia, one case of postoperative pneumonia, 2 cases of pleural effusion, and two cases of delayed gastric emptying. Postoperative hospital stay was 15 (interquartile range: 11-33) days. All 11 patients achieved R0 resection, and the median number of harvested lymph nodes was 14 (interquartile range: 9-19). Eight patients achieved a downstaging effect after conversion therapy. The median time of postoperative follow-up was 9 (interquartile range: 6-19) months, and at the last follow-up, tumor recurrence occurred in 4 patients, with a median progression-free survival of 8 (95% Confidence Interval, 4.06-21.94) months. Conclusion    Conversion surgery can be performed safely for patients with locally advanced gallbladder cancer, providing them with an opportunity to achieve R0 resection and showing a good early prognosis. Further studies are worthy of being conducted in the future.

Key words: gallbladder cancer, locally advanced, conversion therapy, conversion surgery