原发性胆囊癌的诊断和治疗

Diagnosis and the treatment of primary gallbladder carcinoma

目的 探讨提高原发性胆囊癌早期诊断和治疗的有效途径。方法 对我院 1992～ 2 0 0 2年经手术和病理证实的胆囊癌临床资料进行回顾性分析。结果 术前诊断率 73 9% ,B超和CT是诊断胆囊癌的主要检查手段。手术切除率 5 2 2 % ,1年生存率 39% ,5年生存率 6 %。结论 Ⅰ期、Ⅱ期胆囊癌可仅作单纯胆囊切除术 ;Ⅲ期和Ⅳ期需行扩大胆囊切除术 ;Ⅴ期如伴阻黄则尽可能行姑息性胆道内或外引流手术。早期诊断和合理的术式是延长病人生存时间的主要手段。对胆囊癌高危人群应积极行预防性胆囊切除术。

Objective To improve early dianosis and therapeutic efficacy of primary gallbladder carcinoma.Methods A retrospective clinical analysis was made in 46 cases of gallbladder carcinoma proved by operation and pathology in our hospital from 1992 to 2002.Results 73.9% cases were definitely diagnosed before operation.Ultrasonography and CT were the main method of diagnosis of gallbladder carcinoma.Excision was done in 24 cases,the excision rate was 52.2%(24/46).Postoperative 1 and 5 years survival rate were 39% and 6%.Conclusion Cholecystectomy is suitable for stage Ⅰ,Ⅱ gallbladder carcinoma,extended cholecystectomy fits for stage Ⅲ,Ⅳ,the operation of bile duct drainage should be done for stage Ⅴ accompanied by obstructive jaundice.Early diagnosis and the ways of reasonable operation are efficient methods for long term survival of the patients with gallbladder carcinoma.Cholecystectomy is necessary to the patients who are high risk of gallbladder carcinoma.