胆囊切除术中意外发现胆囊癌51例分析

Clinical analysis of 51 cases with gallbladder cancer accidentally found in cholecystolithotomy

目的分析影响胆囊切除术中意外发现的胆囊癌(GBC)病理分期和预后的因素。方法GBC患者51例,均是于胆囊结石行胆囊切除术中意外发现的。其中,单纯胆囊结石33例,合并胆总管结石18例。分析影响GBC病理分期和预后的因素。结果腺癌47例,鳞癌1例,腺鳞癌2例,神经内分泌肿瘤1例。TNM 0期4例,Ⅰ期17例,Ⅱ期21例,Ⅲ期9例。27例行术前增强CT或MRI,均误诊为胆囊炎;其中,13例胆囊壁增厚伴强化,14例胆囊壁强化但无明显增厚区。23例行胆囊癌根治术,5例出现术后并发症,1例术后出血死亡。3年总体生存率和无进展生存率分别为84.3%(43/51)和86.0%(43/50)。胆囊结石发病时间≥5年是预后的不利因素(P<0.05)。与单纯胆囊结石组相比,合并胆总管结石组胆囊结石发病时间较短,TNM分期较低,3年无进展生存率较高(P<0.05)。结论胆囊切除术中意外发现GBC的患者总体预后较佳,但仍可出现TNMⅢ期GBC。术前影像学检查易将GBC误诊为胆囊炎。合并胆总管结石是GBC患者预后的有利因素,原因可能与胆总管结石的存在促使患者早期手术有关。

Objective To analyze the pathological stage and the factors influencing the prognosis of the patients with gallbladder cancer(GBC)found accidentally in cholecystolithotomy.Methods There were 51 patients with GBC,who were accidentally found in cholecystolithotomy.The preoperative diagnosis was cholecystolithiasis in 33 cases(group A)and cholecystolithiasis combined with choledocholithiasis in 18 cases(group B).The pathological stage and the factors influencing the prognosis of the patients were respectively analyzed.Results Of 51 cases,adenocarcinoma was diagnosed in 47 cases,squamous cell carcinoma in one case,adenosquamous carcinoma in 2 cases,and neuroendocrine tumor in one case.There were 4,17,21 and 9 cases with TNM 0,TNMⅠ,TNMⅡand TNMⅢstages,respectively.Twenty-seven patients underwent preoperative enhanced CT or MRI examination were misdiagnosed as gallbladder inflammation,among which,gallbladder wall thickening and enhancement were showed in 13 patients and 14 patients manifested gallbladder wall enhancement but no significant thickening.A radical surgery for GBC was perfomed in 23 patients of whom,5 patients experienced postoperative complications and one patient died of postoperative bleeding during hospital stay.The 3-year overall survival rate(43/51)and 3-year relapse-free survival rate(RFS,43/50)were 84.3%and 86.0%,respectively.The duration of cholecystolithiasis of more than 5 years was an unfavorable prognostic factor(P<0.05).Compared with group A,the patients of group B had shorter duration of cholecystolithiasis,earlier TNM stage and higher 3-year RFS(P<0.05).Conclusion As a whole,the patients with GBC found accidentally in cholecystolithotomy have a better prognosis.However,some of them are staged as TNMⅢ.Preoperative imageological examination may easily misdiagnose GBC as gallbladder inflammation.Cholelithiasis is a good prognostic factor in GBC patients,which may be related to that the exist of cholelithiasis promotes earlier surgery for it.