结石性胆囊炎癌变高危因素的临床研究

Clinical study on relationship between gallbladder carcinoma and gallstone

目的 探讨结石性胆囊炎癌变的高危因素 ,指导临床选择手术治疗结石性胆囊炎的时机。方法 对手术治疗的 2 0 0例结石性胆囊炎病人的临床及病理资料做回顾性分析。结果 (1)胆囊粘膜单纯增生 144例 ,发生率为 72 % ,不典型增生增生 38例 ,发生率为19 % ,浸润癌 7例 ,发生率为 3 5 % ,正常粘膜 11例。浸润癌旁可见中、重度不典型增生 ;各种不典型增生及癌变发生率有随着年龄及胆囊结石的病史延长而升高的趋势 ;(2 )DNA含量及非整倍体细胞百分率 ,AgNOR颗粒计数和颗粒面积呈顺序递增 ,单纯增生 <轻 <中 <重度不典型增生 <癌组织中 ;本组结果提示 ,癌变可能是使细胞增殖活跃 ,从单纯增生、不典型增生至浸润癌的慢性过程。结论 5 0岁以上并有长期的胆囊结石病史 ,尤其是女性 ,是结石性胆囊炎癌变的高危因素 ,故对 5 0岁以上并有长期的胆囊结石病史的病人 ,特别是女性 ,应定期检查 ,必要时行预防性胆囊切除术。

Objective To investigate the risk factors of gallbladder stone changing to gallbladder carcinoma. Methods The clinical data of 200 patients with gallbladder stone undergoing operation were retrospective analysed. Results (1) In the 200 resected gallbladder specimens, gallbladder mucosa hyperplasia was found in 144 specimens(72%), atypical hyperplasia(AHP) in 38(19%), infiltrative cancer in 7(3.5%). All the paracancer mucosa had midder or severe AHP. The incidence of atypical hyperplasia and canceration had increased with patients' age and the history lenth of cyst stone. (2) The content of DNA, the porpotion of euplpoid cells, the AgNOR content in tissues as follows: hyperplasia<mild AHP<midder AHP<severe AHP<canceration. Conclusions The results of this study indicate that the canceration of gallbladder from cyst stone may be a chronic process which from hyperplasia→AHP→canceration. So the risk factors of canceration including age≥50 years; long term history of cyst stone, espically in women; that for cases of cyst stone with age≥50 years, more long term history, especially in women, therefore periodical examinations should be done, and preventive cholecystectomy should be performed if necessary.