原发性胆囊癌诊治分析(附1222例报告)  

Diagnosis and treatment of primary gallbladder carcinoma:A report of 1222 cases

作　　者：孙学军[1] 石景森[1] 王林[1] 王作仁[1] 陈革[1] 郝秀原[1] 卢云[1] 周连锁[1] 杨毅军[1] 赵凤林[1] 王健生[1] 焦兴元[1] 朱爱军[1] 任予[1] 刘刚[1] 田勇[1] 郑见宝[1] 刘绍诰[1] 

机构地区：[1]西安交通大学医学院第一附属医院普外科,陕西西安710061

出　　处：《中国实用外科杂志》2014年第2期179-182,共4页Chinese Journal of Practical Surgery

摘　　要：目的分析原发性胆囊癌（primarycar cinoma of gallbladder，PCG）的临床特点，总结临床诊治经验，探讨影响预后的相关因素。方法回顾性分析西安交通大学医学院第一附属医院1956—2008年收治的1222例PCG临床资料．并进行相关统计分析。结果有明确的病理资料636例，其中腺癌占90．7％，鳞癌和腺鳞癌分别占2．8％和3．6％，其余类型占极少数。2004--2008年行手术治疗的247例中，胆囊癌侵犯肝床或肝转移者152例，有局部及远处淋巴结肿大者107例，其中30例证实为癌转移，32例为腹腔广泛播散。2004-_2008年267例病人的随访资料分析表明，肿瘤分期、手术方式与病人预后有关，而年龄、性别、病理类型、血清CEA及CA19—9与预后无关。生存分析显示，Nevin分期越高，生存曲线下降速度越快；行标准根治手术的病人1—5年存活率及生存时间均高于其他治疗方式。结论PCG早期诊断困难，超声和CT联合检查可作为PCG的常规诊断方法；以手术为主的综合治疗仍是PCG治疗的主要手段，对于PCG病人积极行根治性手术可延长部分病人存活期。Objective To analyze the clinical characters of primary carcinoma of gallbladder （PCG）, summarize the experience of its diagnosis and treatment and discuss the related factors affecting prognosis. Methods The clinical data of 1222 cases of PCG from 1956 to 2008 in the First Affiliated Hospital of Medical College of Xi＇ an Jiaotong University were analyzed retrospectively. The data were processed using statistical methods. Results There were 636 cases of certain pathological data, of which the adenoearcinoma accounted for 90.7%,the squamous cell carcinoma and the gland squamous cell carcinoma 2.8% and 3.6%, respectively, other species accounting for less. Of the 247 cases under went surgical treatment from 2004 to 2008, the liver bed invasion by the gallbladder carcinoma or the liver metastases were in 152 cases, and the local or distant lymph nodes enlarged were in 107 cases, including 30 cases conformed cancer metastasis, 32 cases of abdominal distributed widely. The follow-up data of 267 cases from 2004 to 2008 showed that tumor stage and surgical option had relationship with patient prognosis, while age, gender, histological type, serum CEA and CA19- 9 had nothing to do with prognosis. Survival analysis showed that the higher the Nevin staging curves, the faster the survival curve fall. The 1 to 5 year survival rate and the survival time of the patients with the standard radical surgery treatment were higher than the other forms of treatment. Conclusion It is difficult to make a definite diagnosis of the early PCG. The associated examination of ultrasonic and CT can be regarded as the routine examination of PCG. The comprehensive treatment based on surgery is the primary treatment for the PCG. The radical resection is effective in prolonging life span and improving prognosis of some patients.

关 键 词：原发性胆囊癌 综合治疗 

分 类 号：R6[医药卫生—外科学]