胆囊癌的诊断分析(附127例报告)

The diagnosis of gallbladder cancer

目的 探讨胆囊癌各种诊断方法的价值 ,以期进一步改善胆囊癌患者的预后。方法 回顾性分析本院 1989～ 2 0 0 4年收治的经手术确诊的 12 7例胆囊癌患者的临床资料。结果 最常见症状为持续性右上腹疼痛 90例 ( 70 .87% ) ,腹胀不适 6 5例 ( 5 1.18% ) ,食欲减退 6 0例 ( 4 7.2 4 % ) ,黄疸 5 8例 ( 4 5 .6 7% )及消瘦 38例 ( 2 9.92 % ) ,合并急性胆囊炎 2 4例 ( 18.89% ) ,合并胆囊结石 10 1例 ( 79.5 3% )。血清γ GT明显升高 85例 ( 6 6 .93% ) ,胆汁酸明显升高占 5 1.5 2 % ( 34/ 6 6例 )。影像学检查阳性率分别为B超 82 .6 8% ,CT 85 .0 6 % ,MRI 81.2 5 % ,DSA 6 4 .86 % ,ERCP 5 1.0 2 %。结论 长期胆囊结石患者出现疼痛规律改变 ,尤其伴有血清胆汁酸升高者 ,应高度怀疑胆囊癌 ,及时进行B超及CT检查。凡胆囊结石患者 ,尤其女性、5 0岁以上患者 ,应及时切除病变胆囊 。

Objective To evaluate various diagnositic means for patients with gallbladder cancer.Methods 127 patients with gallbladder cancer admitted into our hospital between 1989 and 2004 were enrolled,and their clinic data were analyzed retrospectively.Results The most common symptoms of patients with gallbladder cancer were upper abdominal pain(70.87%),flatulance(51.18%),anorexia(47.24%) and jaundice(45.67%).Serum γ-GT was positive in 66.93% and the serum bile acid was in 51.52 %.The positive rate of image examination was 82.68% with BUS,85.06% with CT,81.25% with MRI,64.86% with DSA and 51.02% with ERCP,respectively.Conclusions BUS and CT were valuable for the diagnosis of gallbladder cancer.All female patients aged above 50 and with gallbladder stone,especially with high serum level of bile acid,should undertake cholecystectomy.