上海市胆囊癌诊治现状分析

Diagnosis and management for gallbladder carcinoma among Shanghai citizens

目的分析上海地区胆囊癌的诊治现状.方法对1997年6月至2001年5月间上海市390例确诊胆囊癌的病例进行临床病理分析.结果 390例胆囊癌中男108例、女282例,平均年龄64岁,发病率随年龄的增加而上升.有261例(66.9%)合并胆囊结石.主要临床表现为中上腹不适(88.0%)、食欲减退(61.5%)、体重下降(44.4%).行单纯胆囊切除术187例(56.0%)、胆囊癌根治性切除术65例(19.5%)、胆囊癌扩大根治性切除术7例(2.1%)、剖腹探查术74例(22.2%).322例获得病理诊断,腺癌为226例(70.2%)最为多见.0～Ⅳb期的5年生存率分别是100%、58.7%、40.2%、9.2%、13.5%和7.1%,根治性切除、胆囊切除和未切除者的5年生存率分别是40.7%、31.3%和2.6% (P＜0.01).结论提高胆囊癌的早期诊断率,规范胆囊癌的治疗方法是提高疗效的关键.

Objective To analyze the diagnosis and management for gallbladder carcinoma among Shanghai citizens. Method From June 1997 to May 2001, 390 cases of gallbladder carcinoma among Shanghai citizens were enrolled into this analysis. Results There were 108 male and 282 female patients with the mean age of 64 yrs. Gallstone was complicated in 261 （ 66. 9% ） cases. Epigastric discomfort （88.0%）, anorexia （61.5%）, weight loss （44.4%） were among the main clinical manifestations. Cholecystectomy was performed in 187 cases, radical resection in 65 cases, extensive radical resection in 7 cases, exploratory laparotomy in 74 cases. Pathological diagnosis was established in 322 cases. The five year survival rate of patients at 0 to IV b stages was 100% ,58.7% ,40.2% ,9.2%, 13.5% and 7. 1% respectively. The five year survival rate of radical resection,cholecystectomy and non-surgery was 40. 7%, 31.2% and 2.6% respectively. Conclusion Early diagnosis and standardizing management are the key to improve the prognosis of gallbladder carcinoma.