胆囊癌诊治的若干体会

Experience in the diagnosis and treatment of primary gallbladder cancer

目的 总结胆囊癌的诊断和治疗经验。方法 对手术和病理确诊的胆囊癌 134例资料进行回顾性分析。随访 6个月至 16年。结果 B超检查正确率为 5 4 3% (88/16 2 ) ,电脑彩超正确率达 6 9% (2 9/4 2 ) ,CT结合增强扫描正确率达 85 % (46 /5 8)。NevinⅠ期 6例行单纯胆囊切除术 ,其中4例已生存 5年。NevinⅡ～Ⅳ期行胆囊癌根治性切除术 6 6例 ,平均生存 1年 8个月。NevinⅤ期行根治性或扩大根治性胆囊癌切除术 17例 ,平均生存期为 1年 3个月 ;10例NevinⅤ期行姑息性胆囊切除 ,平均生存 6个月 ;NevinⅤ期仅行剖腹探查术 35例 ,平均生存期仅 2个月。结论 电脑彩超可用做诊断早期胆囊癌的首选检查 ,晚期胆囊癌应与黄色肉芽肿性胆囊炎相鉴别。NevinⅤ期病人 ,只要没有腹水、凝血障碍和心肺肝肾的严重器质性病变 ,不应轻易放弃手术探查。

Objective To summerize our experience for the diagnosis and surgical management for primary gallbladder cancer.MethodsIn this study the clinical data of 134 patients suffering from primary gallbladder carcinoma proved by both laparotomy and pathology in our hospital were retrospectively analyzed.Results Patients were 50 men 〔mean age (56±14) years〕 and 84 women 〔mean age (59±16) years〕,followed up for 6 months～16 years.The diagnostic accuracy of B ultrasound was 54 3%(88/162);of color Dopple ultrasound 69% (29/42);of contrast enhanced CT 85% (46/58).Simple cholecystectomy was performed in 6 patients of Nevin's stage Ⅰ,among them 4 cases have survived more than 5 years; 66 cases with Nevin's stage Ⅱ～Ⅳ carcinoma received radical cholecystectomy, the mean survival was 20 months; 17 patients of Nevin's stage Ⅴ received radical or extended radical cholecystectomy,the postoperative mean survival was 15 months whereas 10 patients with Nevin's stage Ⅴ undergoing palliative cholecystectomy had only a mean survival of 6 months; 35 patients with Nevin's stage Ⅴ undergoing a mere laparotomy survived an average of 2 months.Conclusions The colour Dopple ultrasound is the first line diagnostic means for early gallbladder cancer. Xanthogranulomatous cholecystitis should be carefully differentiated from locally advanced gallbladder cancer when a non surgical management was to be employed. Patients diagnosed with Nevin's stage Ⅴ gallbladder carcinoma should undergo laparotomy in an attempt to perform resection provided that the constitutional condition of the patients allows this procedure.