原发性胆囊癌诊治的历史、现状及展望

The history,current status and prospect in the diagnosis and treatment of primary carcinoma of the gallbladder

原发性胆囊癌是胆道系统最常见的恶性肿瘤,其发病率在我国逐年增高。由于原发性胆囊癌无特异性的临床表现,临床发现的胆囊癌多属中晚期,根治性切除率低,预后差。本文就原发性胆囊癌诊治的有关文献,结合本单位50年来945例原发性胆囊癌诊治的临床资料,在胆囊癌发病的高危因素、影像学诊断、分子生物学研究、治疗进展以及存在的问题进行了分析,提出:目前对原发性胆囊癌的早期诊断依然困难,继续深入开展对胆囊癌致病高危因素的基础与临床研究、对胆囊癌的二级预防具有重要的临床意义。以手术为主的综合治疗仍然是原发性胆囊癌治疗的主要手段,肿瘤的基因治疗正逐渐发展成为治疗原发性胆囊癌的一种新方法,已显示出良好的应用前景。

Primary carcinoma of the gallbladder （PCG） is the most common malignant tumor in biliary system and its morbility has been rising year by year in our country. Because there is no specific clinical manifestation, patients diagnosed finally as PCG have mostly been in intermediate or advanced stage, thus losing the chance of radical resection of gallbladder carcinoma and having a poor prognosis. In this article we analyze the high risk factors, diagnosis of imageology, study of molecular biology, therapeutic progression and existent problems about PCG, by reviewing the related literature about diagnosis and treatment of PCG and the clinical data of 945 patients with PCG who were treated in our hospital in recent fifty years. We realize that early diagnosis of PCG is still difficult nowadays, it is very significant for secondary prevention of PCG to continue to carry out the foundamental and clinical study of PCG. Combined therapy that mainly includes surgical operation remains cardinal therapeutic management, and gene therapy has gradually developed to become a new therapy and displays favourable prospect of application.