胆囊癌32例诊治分析与探讨

Diagnosis and treatment of 32 cases of gallbladder carcinoma

目的探讨胆囊癌的危险因素、术前评估及治疗方法。方法回顾分析近10年收治32例胆囊癌,依据影像学检查评估及TNM分期选择合适的手术方式。结果32例中意外胆囊2例,合并胆囊结石22例,繲NM分期:Tis期2例,T1a期2例,T1b期3例,T2期10例,T3期12例,T4期3例。手术行单纯胆囊切除术2例,根治性胆囊切除15例,胆囊扩大切除联合肝外胆管切除高位胆管空肠吻合6例,姑息性肿瘤切除胆肠吻合或肝总管置T管引流5例,胆囊+肝外胆管+肝段(IVb+V段)切除1例,胆囊扩大切除联合胃大部十二指肠球部切除1例,胆囊扩大切除联合结肠肝曲切除2例。结论根治性手术切除是胆囊癌患者的有效治疗手段,手术方式取决于TNM分期,并可辅助化学治疗,总体预后差。

Objective To investigate the risk factors,preoperative evaluation and treatment of gallbladder carcinoma.Meth-ods Retrospective analysis of 32 cases of gllbadder carcinoma treated in recent 10 years,choose the appropriale surgical methods Ac-cording to the imaging examination and TNM stag.Results In the32 cases,There were 2 cases of accidental gallbladder,22 cases with gallstone,TNM stage:There were 2 cases in Tis stage,2 cases in T1a stage,3 cases in T1b stage,10 cases in T2 stage,12 cases in T3 stage and 3 cases in T4 stage.There were 2 cases of simple cholecystectomy,15 cases of radical cholecystectomy,6 cases of dilated chelecystectommy combined with extrahepatic bile duct resection of high bile duct jejunum anastomosis,5 cases of plliative tumor rese-tion with cholecystectomy or T-tube drainage of liver,1 case of Gallbladder+Extrahepatic bile duct+Hepatectomy(IVb+V seg-ment),1 case of dilated cholcytectomy combined with subtotal gastrie duodenal lobectomy and 2 cases ofdilated cholecstectomy com-bined with colonic hepatectomy.Conclusion Radical surgical rsetion is an efctive treatment for patients with gallbladder cancer.The operation method depends on TNM stage and can be adjuvant chemotherapy,and the overall prognosis is poor.