胆囊腺鳞癌的临床特点分析

Clinicopathological features of gallbladder adenosquamous carcinoma

目的分析胆囊腺鳞癌患者的临床特点，为该病的诊断和治疗提供依据。方法回顾性分析2000年1月至2010年12月北京协和医院收治的经病理检查确诊的8例胆囊腺鳞癌患者的临床资料，总结该病的临床病理特点，探讨诊断、治疗和预后。Kaplan-Meier法绘制生存曲线，生存情况分析采用Log-rank检验。结果本组8例患者临床表现无特异性，术前均被误诊为原发性胆囊癌合并胆囊结石、慢性胆囊炎。3／8的患者CEA和GGT高于正常值，2／8的患者ALP高于正常值，1／8的患者ALT高于正常值，3／6的患者CA242高于正常值，4／7的患者CA19-9高于正常值，AST、TBil、DBil均在正常范围。根据肿瘤部位采用不同手术方式，肿瘤平均直径为（5±3）cm。5例患者出现肝门部、肝十二指肠韧带以及胰头后方淋巴结转移。术后病理检查为胆囊腺鳞癌。8例患者随访至2011年4月，2例生存，无明显不适症状，生存时间为2-3个月；6例死亡，死因为肿瘤复发或转移，中位生存时间为8个月（4-13个月）。结论胆囊腺鳞癌临床表现缺乏特异性，明确诊断依靠术后病理检查。根治性手术切除是改善患者预后的惟一有效手段，但总体预后较差。

Objective To analyze the clinicopathological features of gallbladder adenosquamous carcinoma.Methods The clinical data of 8 patients with gallbladder adenosquamous carcinoma who were admitted to the Peking Union Medical College Hospital from January 2000 to December 2010 were retrospectively analyzed. The clinicopathological features, diagnosis and treatment strategies were summarized. The survival curve was drawn by Kaplan-Meier method, and the survival of the patients was analyzed by Log-rank test. Results The clinical manifestation of the 8 patients was non-specific, and all the patients were misdiagnosed as with primary gallbladder cancer complicated with cholecystolithiasis or chronic cholecystitis. The levels of carcinoembryonie antigen and γ-glutamyl transferase of 3 patients were higher than the normal, the level of alkaline phosphatase of 2 patients was higher than the normal, the level of aspartate transaminase of 1 patient was higher than the normal, the level of CA242 of 3 patients was higher than the normal and the level of CA19-9 of 4 patients was higher than the normal. The levels of aspartate transaminase, total bilirubin and direct bilirubin were in the normal range. Different surgical approaches were selected according to different tumor positions. The mean diameter of the tumor was （5±3）cm. Lymph node metastasis was detected at the hepatic hilar, hepatoduodenal ligament and area behind pancreatic head. Postoperative pathological examination confirmed that all the patients were with gallbladder adenosquamous carcinoma. All patients were followed up till April 2011. Two patients survived with no discomfort, and the survival time was 2-3 months. Six patients died of tumor recurrence or metastasis, and their median survival time was 8 months （range, 4-13 months）. Conclusions The clinical manifestation of gallbladder adenosquamous carcinoma is non-specific, and definite diagnosis depends on the results of postoperative pathological examination. Surgical treatment is the only effective method in improving the prognosis of patients with gallbladder adenosquamous carcinoma, and the prognosis of patients is poor.