原发性胆囊癌63例诊治分析

ANALYSIS OF THE DIAGNOSIS AND TREATMENT ON 63 CASES OF PRIMARY GALLBLADDER CANCER

目的总结原发性胆囊癌的诊治经验，探讨其诊断与治疗的有效途径。方法回顾性分析我院1994年1月至2005年6月外科治疗的63例原发性胆囊癌患者的临床病理资料。结果本组中有69．8％（44／63）患者合并胆囊结石。最常见的症状为腹痛、黄疽及消瘦。全部63例病人术前均行B超检查，诊断符合率为68．3％（43／63），有18例病人术前同时行CT或MRCP检查，诊断符合率为83．3％（15／18）。早期癌（NevinⅠ，Ⅱ期）10例（15．9％），中晚期癌（NevinⅢ～V期）53例（84．1％）。10例行单纯胆囊切除术，26例行胆囊癌根治术，4例行扩大胆囊癌根治术，23例行姑息性手术，晚期（Ⅳ～Ⅴ期）病例中有13例行根治术和4例行扩大根治术，根治切除率为42．5％（17／40）。术后39例患者获得随访，其中早期胆囊癌的1年生存率（83．3％）明显高于中晚期胆囊癌（27．3％）（83．3％郴27．3％，P〈0．05），晚期胆囊癌中行根治性切除患者的1年生存率（55．6％）明显高于只行姑息性手术者（55．6％郴11．8％，P〈0．05）（11．8％）。结论提高胆囊癌疗效的关键在于早期诊断，B超和CT等结合可提高胆囊癌的诊断率。对有恶变倾向的胆囊结石患者，应行预防性胆囊切除，积极的根治性或扩大根治性手术有助于改善中晚期病例的预后。

Objective To summarize the experience of the diagnosis and management for primary gallbladder carcinoma, and search the effective approach of its diagnosis and treatment. Methods A retrospective analysis on clinical pathological data was made for 63 cases of primary gallbladder carcinoma patients undergoing surgical treatment in our hospital from January 1994 to June 2005. Results 69.8% （44/63）of all patients were associated with gallstones . The most frequent symptoms were abdominal pain, jaundice and weight-losing. Total of 63 patients underwent BUS before operation, and diagnostic rate was 68. 3% （43/63） , 18 patients underwent BUS with CT or MRCP before operation and diagnostic rate was 83.3% （15/18）. Patients in early stage（ Nevin＇s Stage Ⅰ , Ⅱ ） have 10 cases（15.9% ） ,and patients in advanced and late stages （Nevin＇s Stage Ⅲ - Ⅴ） have 53 cases（84. 1% ）. In this study, 10 cases underwent simple cholecystectomy,26 cases received radical resection,4 extended radical resection and 23 palliative resection. 13 of 40 patients in late stages （Nevin＇s StagelV, V ） received radical resection, and 4 extended radical resection, the rate of radical resection was 42. 5% （17/40）. Postoperative follow-up was abtained in 39 cases, the 1-year survival rate was significantly higher in early stage than that in advanced and late stages（ 83.3% vs 27. 3%, P 〈 0.05 ）. Patients with advanced gallbladder carcinoma underwent radical resection have a higher 1-year survival rate than those underwent palliative treatment （55.6% vs 11.8%, P 〈 0.05 ）. Conclusion The cruxes to improve the curative effect of gallbladder cancer is early diagnosis, the diagnostic rate can be improved by combining BUS with CT. For the gallstones with canceration tendency, preventive cholecystectomy is the effective measure. Radical or extended radical resection may help to improve the prognosis for patients with gallbladder carcinoma in advanced and late stages.