胆囊癌患者的黄疸--晚期疾病的替代标志物

Vijay Kumar Sharma, A. Behari, Supriya Sharma, R. Singh, Ashok Kumar Gupta, Ashish Singh, Rahul, Ashok Kumar, R. Saxena
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摘要

背景:胆囊癌(GBC)是胆道最常见的癌症。R0切除是预测生存率的最重要指标。有黄疸的 GBC 患者比无黄疸的患者生存率更低:方法:对印度北部一家三甲医院胃肠外科在2011年至2020年10年间收治的GBC患者的前瞻性数据进行回顾性分析。提取并分析了患者的人口统计学、临床概况、影像学特征、临床过程、分期和手术程序等数据,以比较有黄疸的 GBC 患者和无黄疸的 GBC 患者的经历:共有 401 例 GBC 患者,其中 75 例有黄疸,326 例无黄疸。伴有黄疸的 GBC 患者出现腹痛、食欲不振、体重减轻、腹部肿块、胃出口梗阻和低白蛋白血症的几率明显较高,症状持续时间较短,入院次数较多,偶然诊断为 GBC 的几率较低(4% 对 10.7%),GB 颈部肿瘤的发生率较高(80% 对 20%)。在 GBC 和黄疸患者中,大多数患者在影像学检查(31%)、腹腔镜检查(11%)或开腹手术(31%)中发现转移性或局部晚期无法切除的疾病,因此无法进行切除手术。只有2.6%的GBC合并黄疸患者可以接受明确的手术治疗,而无黄疸患者的这一比例为71.2%:结论:伴有黄疸的 GBC 患者很可能是晚期、无法切除的疾病。结论:GBC 和黄疸患者很可能是晚期无法切除的疾病,即使经过大量准备工作,完全切除的机会也很小,这需要更广泛、耗时、昂贵的多学科干预。
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JAUNDICE IN PATIENTS WITH GALL BLADDER CANCER- A SURROGATE MARKER OF ADVANCED DISEASE
Background: Gall bladder cancer (GBC) is most common cancer of biliary tract. R0 resection is the most important predictor of survival. Patients with GBC and jaundice do worse than those without jaundice.Methods: Retrospective analysis of prospectively kept data of patients with GBC admitted to the department of Surgical Gastroenterology at a tertiary care hospital in northern India over10 years from 2011 to 2020. Data on patient demography, clinical profile, imaging characteristics, clinical course, staging, and operative procedures was extracted and analyzed to compare the experience of patients with GBC with jaundice and GBC without jaundice.Results: There were 401 patients with GBC; 75 with jaundice and 326 without jaundice. Patients with GBC and jaundice had a significantly higher incidence of pain abdomen, loss of appetite, loss of weight and presence of an abdominal lump, gastric outlet obstruction and hypoalbuminemia, a shorter duration of symptoms, more number of hospital admissions, a less frequent (4% vs 10.7%) incidental diagnosis of GBC and a higher incidence of GB neck tumors (80% vs 20%). In patients with GBC and jaundice detection of metastatic or locally advanced unresectable disease on imaging (31%), laparoscopy (11%) or laparotomy (31%) precluded resection in majority of patients. Only 2.6% patients with GBC and jaundice could undergo definitive surgery as compared to 71.2% of patients without jaundice.Conclusion: Patients with GBC and jaundice are very likely to have advanced, unresectable disease. Chances of complete resection are slim even after extensive preparation requiring more extensive, time-consuming, costly, multidisciplinary interventions.
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