可疑胆囊癌的术前处理

Preoperative management of patients with suspected gallbladder cancer

胆囊癌是胆道系统最常见的恶性肿瘤,其发病隐匿,临床症状缺乏特异性,早期常被并存的胆囊结石、胆囊息肉、慢性胆囊炎等症状所掩盖,发现时大部分患者已属中晚期,手术切除率低.加上胆囊癌高度恶性的生物学行为,对放、化疗不敏感,预后极差,患者总体5年生存率＜5%;若患者能接受R0根治性切除术,5年生存率可提高至21%～69%[1].因此,对可疑胆囊癌患者完善相关检查,及早诊断和行根治性切除术是目前治愈胆囊癌的惟一方法.

Gallbladder cancer is a disease associated with high mortality. Improvement of early diagnosis is of great significance to prolong the survival. Risk factors for gallbladder cancer include gallstones, cholelithiasis, anomalous pancreaticobiliary junction, focal mucosal microcalcifications, and et al.Advances in endoscopic ultrasonography, magnetic resonance cholangiopancreatogram and helical computed tomography have enhanced preoperative diagnosis of gallbladder cancer. Understanding the characteristics of gallbladder cancer with the help of multiple imaging modalities can facilitate accurate diagnosis and may also help in sorting patients to undergo extended resection or an alternative therapy. Resection is currently the most effective and only potentially curative treatment for gallbladder cancer.However, owing to its non-specific symptoms, gallbladder cancer patients often suffer from late diagnosis, and few patients are suitable for surgery. Other treatment strategies such as chemotherapy, radiotherapy, percutaneous biliary drainage, palliative surgery are used in patients with advanced gallbladder cancer.For jaundiced gallbladder cancer patients, preoperative biliary drainage is still under debate. Since biliary inflammation adversely affects the prognosis of gallbladder cancer patients,antibiotics with high concentration in bile is recommended for selected patients. Palliative treatment and molecular target therapy are promising for patients with inoperable gallbladder cancer.