| Methods: To analyze the diagnosis,surgical treatment and prognostic factors of primary gallbladder cancer(PGBC).Methods: The clinical data of 93 patients admitted in our hospital during Jan.2010 to Dec.2015 were retrospectively analyzed.The demographic characteristics,clinical characteristics,results of imaging and laboratory examination,pathological diagnosis,follow-up and survival situations were analyzed.The demographic characteristics(age,sex,blood type),clinical characteristics(tumor markers,preoperative jaundice,gallstones,tumor pathological type,tumor differentiation,liver invasion,lymph node metastasis,T stage,N stage,M stage,TNM stage,surgical method,incidental gallbladder cancer)were chosen for univariate and multivariate analysis.The effect of surgical method on prognosis and length of hospital stay in advanced and the elderly primary gallbladder cancer patients was analyzed by Student's test method.Results: Among the 93 patients,30 were males and 63 were females,with the average age of(65.0±11.3)years old and length of hospital stay(18.2±8.7)days.There were 76 patients with discomfort or pain in the right hypochondriac region(81.7%),37 patients with fatigue and anorexia(39.8%),26 patients with body weight loss(28.0%),11 patients with nausea and vomiting(11.8%),9 patients with abdominal distension(9.7%),5 patient with abdominal masss(5.4%),5 patients with fever(5.4%),and 9 patients with no obvious symptoms(9.7%).Among all the patients,67 were combined with gallstones(72.0%).The detection rates of AFP,CEA,CA125 and CA199 were 6.5%,21.2%,28.0% and 39.8%,respectively in this study.The detection rate of two or more tumor markers was 55.9%.The detection rates of type-B ultrasonic,CT,and MRI on primary gallbladder cancer were 78.5%,87.0% and 83.8%.All the patients underwent surgery,including 64 undergoing R0 radical resection,29 undergoing palliative surgery.There were 16 cases of incidental gallbladder cancer(17.2%).The pathological type was mainly adenocarcinoma.Well,Moderately,Low and Poorly differentiated tumors were respectively confirmed in 7(7.5%),46(49.5%),28(30.1%)and 12(12.9%)patients.Stage ?,?,? and ? were respectively confirmed in 22(23.7%),15(16.1%),15(16.1%)and 27(29.0%)patients.There were hepatic metastases in 54 cases(58.1%),lymph node metastases in 46 cases(49.5%).All patients got followed up after surgery,with the median follow up duration of 13.0 months(range,1.0-87.0 months),with a median survival time of 13.0 months and average survival time of(30.0±3.4)months,of which 24 patients are still alive.The 1-,3-,5-year survival rates were 50.5%,31.4% and 20.7% respectively.Conclusions: 1.The aged and females are at increased risk of primary gallbladder cancer.Primary gallbladder cancer is usually not associated with readily discernible clinical signs.The combination of multiple examination methods can improve the diagnosis rate of gallbladder cancer.Comprehensive treatment based on radical surgery is the most effective therapeutic option for gallbladder cancer.2.The results of univariate analysis showed that CA199 abnormal,CA125 abnormal,preoperative jaundice,tumor differentiation,liver invasion,lymph node metastasis,T stage,N stage,M stage,TNM stage,surgical method,incidental gallbladder cancer were risk factors affecting the prognosis of patients.3.The results of multivariate analysis showed that CA199 abnormal,tumor differentiation,lymph node metastasis,TNM stage,incidental gallbladder cancer were independent risk factors affecting the prognosis of patients.4.For patients with advanced primary gallbladder cancer and aged patients,radical surgery can achieve a better prognosis than palliative surgery and does not prolong the length of hospital stay. |
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