意外胆囊癌的临床处理与预后分析

Surgical treatment and prognosis of incidental gallbladder carcinoma：a study of 27 cases

目的 总结意外胆囊癌的临床病理特点、诊断与治疗方案的选择,分析与预后有关的因素,指导意外胆囊癌的规范化治疗.方法 回顾性分析北京协和医院1999年1月至2009年10月收住院治疗的27例意外胆囊癌的临床资料,应用Kaplan-Meier法对比单纯胆囊切除术组、胆囊癌根治术组以及NevinⅠ、Ⅱ期与Ⅲ、Ⅳ、Ⅴ期患者的累积生存率,对意外胆囊癌的治疗方法与预后进行分析.结果 27例患者以胆囊良性疾病的术前诊断行胆囊切除术,术前诊断以急慢性胆囊炎、胆囊结石和胆囊息肉为主.术后病理学检查证实为胆囊癌,其中低分化腺癌9例,中分化腺癌9例,高分化腺癌4例,腺瘤癌变5例.按Nevin分期,Ⅰ期2例,Ⅱ期5例,Ⅲ期8例,Ⅳ期5例,Ⅴ期7例.胆囊癌根治术组患者累积生存率好于单纯胆囊切除术组（x2=4.450,P=0.035） Nevin Ⅰ、Ⅱ期患者预后显著优于Ⅲ、Ⅳ、Ⅴ期（x2=6.825,P=0.014）.结论 意外胆囊癌临床表现缺乏特异性,容易导致误诊,术中快速病理切片检查是明确诊断的重要方法,确诊后首选根治性切除术.

Objective To summarize the clinical and pathological characteristics of incidental gallbladder carcinoma,analyze the factors such as surgical procedures,tumor stages that associated with prognosis,and standardize the diagnosis and treatment strategy of incidental gallbladder carcinoma. Methods Between January 1991 and October 2009,27 incidental gallbladder carcinoma patients were treated in Peking Union Medical College Hospital （PUMCH）.A retrospective study was performed based on the clinical data of these patients to evaluate the methods of diagnosis,curative treatment and prognosis. Results Twenty-seven patients were collected （8 male and 19 female） with the mean age of （68.3 ± 1.9）years.Abdominal pain,obstructive jaundice and fever were the main symptoms of incidental gallbladder carcinoma.All the 27 cases underwent open cholecystectomy based on preoperative tentative diagnosis of benign disease,and carcinoma of gallbladder was confirmed by postoperative pathology.In this group（9 lowdifferentiation,9 moderate-differentiation,4 high-differentiation and 5-carcinogenesis from adenoma）.Two cases were on the stage of Nevin Ⅰ,5 on Nevin Ⅱ,8 on Nevin Ⅲ,5 on Nevin Ⅳ and 7 on Nevin Ⅴ.The survival terms were of statistic significance between the radical cholecystectomy groups and simple cholecystectomy groups（x2 =4.450,P=0.035） The prognosis of patients on stages Ⅰ、Ⅱ are better than those who are on stages Ⅲ、Ⅳ、Ⅴ （x2 = 6.825,P = 0.014）. Conclusion The clinical manifestations of incidental gallbladder carcinoma are diverse,which usually lead to misdiagnosis.Frozen section examination during operation is key to diagnose incidental gallbladder carcinoma.Surgical operation is the first choice of therapy,offering much better prognosis than those received simple cholecystectomy.