原发性胆囊癌44年诊治的临床回顾  

44-Year Experience in Diagnosis and Treatment of Primary Gallbladder Carcinoma

作　　者：石景森[1] 杨毅军[1] 赵凤林[1] 王作仁[1] 周连锁[1] 王林[1] 王健生[1] 何平[1] 卢云[1] 孙立江[1] 焦兴元[1] 刘绍诰[1] 

机构地区：[1]西安交通大学第一医院肝胆外科研究室,710061

出　　处：《外科理论与实践》2001年第3期137-141,共5页Journal of Surgery Concepts & Practice

摘　　要：目的：总结原发性胆囊癌的诊治经验，以利全面地认识本病、完善地制订诊治方案，提高疗效。方法：回顾性 分析我院４４年来收治的６９９例原发性胆囊癌临床资料。结果：６９９例胆囊癌患者中，男１９３例，女５０６例，男女之比为１： ２．６；年龄２５—８５岁，平均５６．４岁，５５岁以上者占６５．５％。有３８１例（５４．５％）合并胆囊良性疾病，胆囊结石占３６７例 （５２．５％）。病理类型：腺癌９４．９％，腺瘤癌变０．６％，息肉癌变１．２％，鳞癌１．５％，腺鳞癌１．８％； ＮｅｖｉｎⅠ期１．５％， Ⅱ期 １７．４％，Ⅲ期１６．２％，Ⅳ期２４．１％，Ⅴ期４０．８％。Ｂ超检查确诊率为７４．０％（３６５／４９３），ＣＴ检查确诊率为８７．６％（８５／９７）。 ２３４例行非手术治疗，４６５例行手术治疗。单纯胆囊切除术７９例，根治性胆囊切除术４７例，扩大切除术１９例。早期病例 单纯胆囊切除术后５年生存率优于晚期病例扩大切除术（Ｐ＜０．０５），对于Ⅱ期病例，根治性胆囊切除术后５年生存率 高于单纯胆囊切除术（Ｐ＜０．０５）。结论：改善胆囊癌预后的关键是：①加强高危人群监测，研究新的诊断技术和指 标，真正提高早期诊断水平；②对早期病例应尽量做根治性胆囊切?Objective: To summarize the experience of diagnosis and treatment of primary gallbladder carcinoma (PGC). Methods: Six hundred and ninety-nine cases of PGC admitted from 1956 to 1999 were analyzed retrospectively. Results: Of 699 patients with PGC, 193 were male, and 506 female(male:female=1:2.6), age range 25～85 years, the mean age was 56.4 years, and 65.6% of the patients were over 55 years old. The histological patterns were as follows: adenocarcinoma 94.8%, c arcinomatous change of adenoma 0.6%, malignant change of polyp 1.2%, squamous carcinoma 1.5% and adenosquamous carcinoma 1.8%. Nevin's staging from Ⅰ～Ⅱ were 1.5%, 17.4%, 16.2%, 24.1% and 40.8%, respectively. The diagnostic rate by BUS was 74.0%(365/493), that of CT was 87.6%(85/97). Four hundred and sixty-five patients were operated. Among them, simple cholecystectomy was performed in 79 cases, radical resection in 47, and extended resection in 19. The 5-year survival rate of the early PGC cases after simple cholecystectomy was significantly higher than that of advanced cases after ex- tended resection(P<0.05). For Nevin Ⅱpatients, 5-year survival rate of radical resection was higher than that of simple cholecystectomy(P<0.05). Conclusions: To improve the prognosis of PGC, the key points are as follows: ①Enhancement of monitoring the high risk population and improving the level of early diagnosis. ②Radical resection should be adopted for early cases, and extended resection should be carried out for advanced cases. ③Multidisciplinary treatment should be performed. ④Modern molecular biologic technique should be adopted in research of the etiology and diagnosis of PGC, and of the biotherapy.

关 键 词：原发性胆囊癌 诊断 治疗 

分 类 号：R735.8[医药卫生—肿瘤]