不同分期胆囊癌的外科术式选择

Operation Choices for Gallbladder Carcinomas at Different Stages

目的探讨不同分期胆囊癌的外科治疗方式及其疗效。方法74例手术治疗胆囊癌患者根据不同TNM分期采取相应的手术方式：7例Ⅱ、Ⅲ期病例行单纯胆囊切除；24例Ⅲ期患者行胆囊癌根治术；35例ⅣA、ⅣB期病例行胆囊癌扩大切除术；另8例Ⅳ期胆囊癌因肝门部骨化合并梗阻性黄疸行IVb段肝切除＋胆囊切除＋胆肠吻合。其中10例ⅣB期病例附加腹腔动脉、胰头周围淋巴结酒精注射，9例ⅣB期病例附加I131粒子植入；35例胆囊癌扩大切除患者均附加肝段切除术；3例附加横结肠切除吻合；2例附加门静脉部分切除，4例附加肝右动脉切除。结果围手术期死亡1例；发生胆漏3例，腹腔感染9例；糖尿病酮症酸中毒1例。术后住院时间平均15．2（10～25）d。随访34例，平均11．2（1～31）月，3例术后1年内死亡，7例术后1～2年死亡，25例局部复发。最长生存29月。结论绝大部分胆囊癌发现时处于晚期；针对不同分期和部位选择合适的外科手术治疗手段可以有效延长患者寿命、改善症状、提高生存质量。

Objective To evaluate the therapeutic efficacy of different operative choices for gall bladder carcinoma at different stages. Methods Different procedures were used in 74 cases of gall bladder carcinoma at different TNM stages, including simple cystectomy in 7 cases of StageⅡ and Ⅲ, radical resection in 24 cases of Stage Ⅲ, extended resection plus hepatic segmentectomy in 35 cases of Stage IVA and IVB, and hepatectomy of Ⅳb segment ＋ cystectomy ＋ cholandochojejunostomy in 8 with sclerotization of hepatic hilum. The additional treatment included alcohol injection around celiac artery and pancreatic lymph nodes in 10 cases, I131implantation in 9 cases, transverse colon resection in 3 cases, portal vein resection in 2 cases, and right hepatic arteria resection in 4 cases. Results 1 case died postoperatively. 3 cases occurred bile leakage, 9 cases occurred abdominal infection, and 1 case suffered from diabetic ketosis. Postoperative hospitalization was 15.2（ 10 ~25）days in average. In 34 cases followed up for meanly 11.2（ 1 ~ 31 ） months, 3 cases died within 1 year, 7 cases died within 1 to 2 years, and 25 local relapsed. The longest survival time was 29 months. Conclusion Most patients of gallbladder carcinoma are found at advanced stage. Choosing suitable operative procedures according to different stages and different locations can prolong survivals, relieve symptoms and improve life qualities for gall bladder carcinoma patients.