胆囊癌假阴性诊断因素分析

Analysis of factors of false negative diagnosis of primary gallbladder cancer

目的 :讨论原发性胆囊癌误诊原因以提高诊断率。方法 :对近 8年 5 0例经病理证实为胆囊癌的临床表现 ,影像学特点和术中判断进行回顾分析。结果 :①临床表现 :右上腹不适 ,饱胀感为 74 % ,恶心、呕吐为 4 4 % ,消瘦为 30 % ,右上腹明显疼痛为 2 6 % ,黄疸为 2 0 %。入院诊断符合率为 4 6 % ,不符合率为 5 4 %。②所有病例均经B超检查 ,4 0例行CT检查。B超诊断符合率为 74 % ,假阴性率为 2 6 % ,CT诊断符合率为92 .5 % ,假阴性率为 7.5 %。B超联合CT检查提高诊断符合率达 94 % ,对胆囊壁不规则增厚及腔内广基的软组织肿块应警惕胆囊癌的可能。③术中对肉眼和手感发现胆囊壁不规则增厚者 ,应按常规作胆囊剖开及术中冰冻病理检查。结论 :重视腹痛、消瘦、黄疸患者的临床表现 ,对胆囊壁不规则增厚、胆囊腔内广基的软组织肿块影像学特点及术中判断胆囊壁不规则增厚、质稍硬者 ,应作常规冰冻病理检查 ,这是提高胆囊癌诊断率的重要环节。

Objective:To discuss the factors of false negative diagnosis of gallbladder cancer in order to raise correct diagnostic rate.Methods:Retrospective analysis of clinical manifestation,sonography and screening character and per operative evaluation for 50 cases of gallbladder cancer confirmed by pathological examination in recent 8 years.Results:①Clinical manifestation:discomfort in right hypochondria and dyspepsia being of 74%,nausea and vomiting of 44%,loss of weight of 30%,predominate pain in right hypochondria of 26%,jaundice of 20%,coincidence rate of gallbladder cancer of pre hospitalization of 46% and non coincidence rate of 54%.②Coincidence rate being of 74% and false negative rate of 26% by sonography examination for all cases,and coincidence rate of 92.5% and false negative rate of 7.5% by screening tomograpy for 40 cases. Coincidence rate can arrive at 94% by sonography combined with CT examination. Gallbladder cancer should be watched out for the irregular hyperplasia of gallbladder wall and large basic mass in cavity of gallbladder by CT.③Gallbladder should be cut open and the specimen then taken for ice pathological examination during operation when irregular hyperplasia of gallbladder wall was found by naked eye and palpation.Conclusion:There are three links for raising coincidence rate:pay attention to clinical manifestations such as abdominal pain,loss of weight and jaundice,maintain vigilance to irregular hyperplasia of gallbladder wall and screening character of large basic firm mass in gallbladder cavity and perform ice pathological examination routinely in case of gallbladder wall irregular firm hyperplasia by evaluation during operation.