目的：探讨不同手术方式对于IV期胆囊癌患者远期预后的影响作用。方法：回顾性分析手术治疗的134例IV期胆囊癌患者的临床与随访资料，其中采用姑息切除术44例（姑息手术组）、采用胆囊癌根治术或扩大根治术治疗56例（根治性手术组）、胆道内外引流术治疗34例（引流组），比较3组患者的远期预后情况。结果：对于IVa期胆囊癌患者，3组的术后1年生存率差异无统计学意义（P>0.05），但根治性手术组的术后3年生存率明显高于姑息手术组和引流组（17.2% vs. 0.0% vs. 0.0%，均P<0.05）；根治性手术组术后的中位生存时间18个月，明显长于姑息手术组（14个月）和引流组（12个月）（χ2=12.094；14.876，均P<0.05）。对于IVb期胆囊癌患者，3组术后1、3年生存率差异均无统计学意义（均P>0.05）；根治性手术组术后的中位生存时间14个月，明显长于姑息手术组（9个月）和引流组（9个月）（χ2=8.741，χ2=8.839，均P<0.05）。结论：IV期胆囊癌患者早期采用根治性切除术有利于改善患者的远期预后。
Effects of different surgical methods on prognosis of patients with stage IV gallbladder carcinoma
Objective: To investigate the effects of different surgical methods on the long-term prognosis of patients with stage IV gallbladder carcinoma. Methods: The clinical and follow-up data of 134 patients with stage IV gallbladder carcinoma undergoing surgical treatment were retrospectively analyzed. Of the patients, 44 cases underwent palliative resection (palliative surgery group), 56 cases received radical or extended radical treatment for gallbladder carcinoma (radical surgery group), and 34 cases only had internal and external biliary drainage (drainage group). The long-term results among the three groups of patients were compared. Results: For patients with stage IVa gallbladder carcinoma, there was no statistical difference among the three groups in postoperative 1-year survival rate (P>0.05), but the postoperative 3-year survival rate in radical surgery group was significantly higher than that in palliative surgery group or drainage group (17.2% vs. 0.0% vs. 0.0%, both P<0.05). The median postoperative survival time in radical surgery group was 18 months, which was significantly longer than that in palliative surgery group (14 months) and drainage group (12 months) (χ2=12.094; 14.876, both P<0.05). For patients with stage IVb gallbladder carcinoma, both postoperative 1- and 3-year survival rates showed no statistical difference among the three groups (both P>0.05); the median postoperative survival time in radical surgery group was 14 months that was significantly longer than that in palliative surgery group (9 months) and drainage group (9 months) (χ2=8.741; 8.839, both P<0.05). Conclusion: Early radical resection may be helpful for improving the long-term outcomes of patients with stage IV gallbladder carcinoma.