原发性胆囊癌58例分析

Surgical treatment of the primary gallbladder cancer in 58 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 1990～ 2 0 0 0年收治的 5 8例胆囊癌病例的临床资料。结果 5 8例患者中 ,男性 2 1例 ,女性 37例。B型超声与CT的确诊率分别为 5 9.6 %、72 %。手术切除率为 4 7.4 % ,无手术死亡。Ⅰ、Ⅱ期病例行单纯胆囊切除即可获得良好的生存率 ,其 3年存活率为 10 0 % ,5年存活率为 75 % ,Ⅲ、Ⅳ期病例行根治术后 2年存活率为 4 6 .2 % ,Ⅴ期病例术后存活多不超过 1年。结论 B型超声与CT仍是诊断原发性胆囊癌的重要手段。手术是治疗原发性胆囊癌的首选方法 ,早期诊断和早期根治性手术是提高原发性胆囊癌生存率的关键。对有高危因素的患者 ,应早期行胆囊切除术。

Objective To sum up the experience of the surgical treatment and to improve the prognosis of the primary gallbladder cancer.Methods An analysis was made on 58 cases of gallbladder cancer in our hospital from 1990 to 2000, retrospectively.Results There were 21 males and 37 females (M∶F=1∶ 1.76 ). 38 cases underwent cholecystectomy with a resection rate of 47.4 % and a mortality rate of 0. There were 41 cases ( 59.6 %) definitely diagnosed by preoperative ultrasonography, and 18 (72%) by CT. Long term survivals were achieved almost only in the cases of stage Ⅰ and Ⅱ with 3 year survival rate of 100 % and 5 year survival rate of 75 %. Two year survival rate in stage Ⅲ and Ⅳ cases was 42.9 % after radical cholecystectomy. Almost all stage Ⅴ cases died in 1 year postoperation.Conclusions Ultrasonography and CT scan were important to preoperative diagnosis. Surgical operation is the first choice of therapy. Early diagnosis and radical resection are still the mainstay for long term survival of the patients with primary gallbladder cancer. Cholecystectomy is recommended for high risk patients.