原发性胆囊癌69例的外科治疗

Surgical treatment of gallbladder cancer in 69 cases

目的 总结原发性胆囊癌的治疗经验 ,探讨提高原发性胆囊癌生存率的方法。方法回顾性分析了我院 1986～ 1999年收治的 6 9例胆囊癌病例资料。本组诊断依赖于临床表现和影像学检查 ,Ⅰ期 4% ,Ⅱ期 7% ,Ⅲ期 15 % ,Ⅳ期 17% ,Ⅴ期 5 7%。 6 8%的病例行手术治疗。结果 本组术前诊断率 84% ,B超和CT是提高诊断率的重要手段。手术切除率 49% ,长期存活者仍以Ⅰ、Ⅱ期病例为主 ,单纯胆囊切除术即可获得良好的存活率 ,3年为 10 0 % ,Ⅲ期病例术后的 2年存活率为 5 0 %。结论 手术是治疗Ⅰ、Ⅱ、Ⅲ期病例的首选方法 ,手术能使Ⅳ、Ⅴ期患者的短期存活率稍有延长 ,早期诊断和手术切除是提高手术疗效的关键。对有高危因素的无症状胆囊结石和隆起样病变患者 。

Objective To evaluate the surgical treatment and to improve the prognosis of gallbladder cancer. Method A retrospective analysis was made on 69 cases of gallbladder cancer in PUMC hospital from 1986 to 1999. Diagnosis depends upon clinical manifestation, ultrasonography, and CT. In this group, stage Ⅰ cases took up to 4%,stage Ⅱ to 7%,stage Ⅲ to 15%,stage Ⅳ to 17%, and stage Ⅴ to 57%. 47 cases(68%) underwent surgery. ] Result[Preoperative diagnosis rate is 84% with resection rate of 49%. B mode ultrasonic examination and CT scan were important to preoperative diagnosis. Long term survivals were achieved almost only in cases of stage Ⅰ and Ⅱ with 3 year survival rate of 100%. 2 year survival rate in stage Ⅲ cases was 50%. Conclusion Surgical operation is the first choice of therapy. Prophylactic cholecystectomy is recommended for high risk patients with asyptomatic gallstones or polypoid lesions.