原发性胆囊癌诊治分析

An Analysis of the Diagnosis and Surgical Treatment in Primary Carcinoma of the Gallbladder

目的 分析原发性胆囊癌的临床表现、诊断与治疗 ,以提高诊治能力。方法 回顾性分析 1985— 2 0 0 0年连续收住院手术并病理证实的原发性胆囊癌 42例。结果 合并有胆囊结石 5 4 76% ,右上腹隐痛、不适、饱胀感 83 3 3 % ,明显消瘦 3 8 0 9% ,黄疸16 67% ,发热 7 1% ,胆囊包块 3 5 71% ,B超检查阳性率为 64 2 9% ,CT结合增强扫描检查阳性率为 70 5 9%。本组均行手术治疗。切除原发病灶 2 0例 ( 4 7 6% ) ,其中根除性胆囊癌切除术 7例 ( 16 7% ) ,扩大根除性手术 3例 ( 7 1% ) ,手术证实胆囊癌侵入肝脏 3 3例 ( 78 5 7% ) ,侵犯肝外胆管或肝门 2 5例 ( 5 9 5 2 % )。UICC分期 ,Ⅰ期 3例 ,Ⅱ期 3例 ,Ⅲ期 13例 ,Ⅳa期 17例 ,Ⅳb期 6例。Ⅰ ,Ⅱ期已有 3例生存期超过 5年 ,Ⅲ、Ⅳ期病例平均生存期分别为 16个月、4个月。本组 3 3例术后进行辅助治疗 ,均未延长生存时间。结论 原发性胆囊癌早期诊断较困难 ,应重视腹部隐痛、消瘦、黄疸等表现 ,动态随访观察 ,结合B超、CT检查综合考虑。对术中可疑病例常规冰冻病理检查 ,有助于提高诊断率 ,减少再手术危险。

Objective To investigate the clinical manifestation, the diagnosis and surgical treatment of primary carcinoma of the gallbladder.Methods The retrospective investigation was done for the records of 42 patients with pathologically proven primary carcinoma of the gallbladder,they were received consecutively and treated at our hospital from 1985 to 2000.Results 23 patients associated with cholelithiasis (54.76%).Discomfort in right hypochondria and dyspepsia were 83.33%, loss of weight 38.09%,jaundice 16.67%, gallbladder mass 35.71%.Diagnostic accuracy of B-us was 64.29%,CT was 70.59%. Simple cholecystectomy alone 5 cases,radical cholecystectomy 7 cases, extended radical cholecystectomy 3 cases,cholecystectomy plus T-tube drainage 5 cases, laparotomy with external or internal biliary drainage、gastrointestinal bypass or only biopsy 22 cases. 33 patients received miscellaneous adjuvant therapy after operation, the efficiency was not satisfactory.Conclusions It is necessary to maintain vigilance to clinical manifestations such as abdominal pain,loss of weight and jaundice and to perform ice pathological examination routinely in case of gallbladder.Active operation offers the only chance of cure.