胆囊癌的诊断和治疗

The diagnosis and treatment of primary gallbladder carcinoma

为了探讨胆囊癌的早期诊断和合理治疗，总结我院过去15年间收住58例胆囊癌病例的诊疗经验。患者平均年龄65．8±9．5岁，4O例伴有胆囊结石，平均胆石症病程11年。B超诊断胆囊癌的敏感性为67．9%，CT为61．8％。组织学类型以腺癌为主。44例作了手术，肿瘤切除率为39．7％，根治性切除率为17.2／，两者1、3、5年生存率分别为43.4%、31.9%、23.1％和88.9%、62.5％、28.3％。总5主生存率5.1％。作者认为：(1）胆囊息肉样病及应密切随访；（2)年龄＞60岁或胆石症病史超过10年，尤其影像学检查示胆囊壁增厚或萎缩性胆囊炎应切除胆囊；（3）胆囊标本应常规剖拉，有助于早期发现胆囊癌。治疗上I期病例采用胆囊切除术，Ⅱ和Ⅲ期病例应未用扩大胆囊切除附加淋巴结清扫。

To investigate the way of early diagnosis and proper treatment of carcinoma of gallbladder, 58 cases wereevaluated. Mean age was 65. 8±9. 5, the ratio fo male and female was l:1. 9, 40 cases were accompanied with gallstone, the history of gallstone symptom was 11 year. The sensitivity of B-US and CT was 67. 9% and 61.8%,respecrespectively. The main kind of histology is adenocarcinoma. 44 cases were operated, on the rate of removal and radical operation was 39. 7 % and 17. 2 %, the survival rate of 1. 3. 5 year of two kinds of operation was 43. 4%. 31. 9% .23. 1 % and88. 9%. 62. 5%. 28. 1 %,respectively. The total survival rate of 5 years was 5. 1 %. The results showed that polypoidchange of gallbladder, age>60 years old, history of gallstone>10 years and routine biopsy were useful to early diagnosis. Cholecystectomy should be performed for stage I cases and extended cholecystectomy plus locoreginal lymph nodaldissection for stage Ⅱ Ⅲcases.