胆囊癌误诊原因分析

Misdiagnosis and response measures of gallbladder carcinoma

目的探讨胆囊癌的误、漏诊原因及应对措施。方法对在2000年1月至2006年7月间我院胆囊切除术中或术后发现的12例胆囊癌的临床资料进行回顾性分析。结果本组T1期2例、T2期1例行单纯胆囊切除术；T2期5例，T3期3例再次手术行胆囊癌根治术；T4期1例行姑息性手术。T1期2例至今已健康存活7年和8年；T2期有3例分别于术后12、39、78个月死亡；T3期3例分别于术后5、12、16个月死亡；T4期1例于术后3个月死亡。5年存活率T1期为100％，T2期为66．6％，L、T4期为0。结论胆囊癌病人的存活率与肿瘤分期相关。原位癌（Tis）、T1期胆囊癌行单纯胆囊切除术即可，对T1期以上的胆囊癌应尽量行开腹胆囊癌根治术。

Objective To investigate the reasons of misdiagnosis or missed diagnosis of gallbladder carcinoma （GC） and the response measures. Methods From January 2000 to July 2006 in our hospital,out of 2600 cases receiving cholecystectomy during or after operation, 12 patients were diagnosed as GC, whose clinical data were retrospectively analyzed. Results Three cases （2 cases of T1 stage and 1 case of T22 stage） underwent cholecystectomy. Eight cases （5 cases of T2 stage and 3 cases of T3 stage） were subjected to radical resection for gallbladder carcinoma. One case of T4 state was treated by routine palliative operation. Two cases of T1 stage had survival time of 7 years and 8 years respectively. Three cases of T2 stage were died at 12th,39th and 78th month after operation respectively. Three cases of T3 stage were died at 5th, 12th and 16th month after operation respectively. One case of T4 stage was died at 3rd month after operation. The 5-year survival rate of patients at T1, T2 and T3/T4 stage was 100 % ,66. 6 % and 0 respectively. Conclusion The survival rate of GC patients is correlated with tumor stage. Carcinoma in situ （Tis）, and T1-stage gallbladder carcinoma can be treated with cholecystectomy. The radical resection for gallbladder carcinoma as early as possible is recommended for GC at T2 stage or over.