上海市胆道癌病理形态特征的初步观察：附487例分析

Preliminary observation of pathologic characteristics of biliary tract cancers in Shanghai: Analysis of 487 cases

目的研究上海市区居民胆道癌病理形态特征和鉴别诊断。方法自1997年6月～2001年5月在上海市区开展基于全人群的胆道癌病例-对照研究,总共收集病理切片1228例,包括胆道癌487例(其中胆囊癌322例,肝外胆管癌105例和壶腹癌60例),胆道结石和胆囊炎对照病例721例,胆道腺瘤20例,由中、美资深病理医师复查,按世界卫生组织1991年胆囊和肝外胆管肿瘤组织学分型进行分类。结果病理标本以切除标本为主,肿瘤大小为多数小于4cm,组织学类型中70％以上为腺癌,肿瘤组织学分级以高分化和中分化占绝大多数,TNM分期中0～Ⅱ期的胆囊癌和肝外胆管癌约占1／3,壶腹癌近2／3。病理复查结果显示诊断过头占1．8％,诊断不足占0．6％,漏诊占0．1％；随访结果显示根治术后的5年生存率：胆囊癌40．7％、肝外胆管癌11．1％和壶腹癌26．9％。结论病理复查可以统一诊断标准,提高确诊率,为全人群病例-对照研究和多学科协作积累经验。

Objective To investigate the pathological characteristics and differential diagnosis of the biliary tract cancer in the citizens of urban Shanghai. Methods A population-based case control study was performed for patients with biliary tract cancer from June,1997 to May,2001. Slides for 1 228 cases were collected,including 487 cases of biliary tract cancer （322 cases of cancer of the gallbladder, 105 cases of extrahepatic bile duct cancer and 60 cases of cancer of the ampulla）. There were 721 cases of stones of the bile duct and cholecystitis as control,and 20 cases of adenoma of the bile tract. All slides were reviewed by senior pathologists from both China and USA, and classified according to WHO histological typing of tumors of gallbladder＇ and extrahe- patio bile duct （1991）. Results Quality of the slides was satisfactory and the majority of the samples were taken from resectional spechnens. Most of the tumors were less than 4cm in diameter. More than 70 % of the tumors were adenocarcinomas, and the rest were papillary adenocarcinomas and mutinous adenocarcinomas. Ahnost all histologic grades of tumors were of high and middle differentiations. Carcinomas of the gallbladder and extrahepatic bile duct accounted for 1/3 stage 0-Ⅱ（TNM staging） cases and carcinoma of the ampulla 2/3. The pathological review showed 1.8 % overdiagnosis,0.6% underdiagnosis and 0.1 %misdiagnosis. Follow-up revealed thai the 5-year survival rates after radical resection were 40.7 %for cancer of the gallbladder, 11.1 % for cancer of the extrahepatic bile duct and 26.9% for cancer of the ampulla. Conclusions The pathologic type of over 70% biliary tract cancers in urban Shanghai were adenocarcinoma,and most tumors were of high and middle differentiation. The 5-year survival rates after radical resection were 40.7% for cancer of the gallbladder, 1 1.1 % for cancer of the extrahepatic bile duct and 26.9% for cancer of the ampulla. The pathological review is helpful in unifying the criteria of diagnosis and enhancing the diagnostic accuracy. This investigation offers its preliminary experiences for population-based case control study as well as for multidisciplinary collaboration.