胆囊癌合并急性胆囊炎21例临床分析  

Clinical analysis of 21 cases of gallbladder carcinoma complicated with acute cholecystitis

作　　者：何嘉琦[1] 朱荔勇 蔡建华[1] 张统一[1] 刘猛[1] 王巍[1] He Jiaqi;Zhu Liyong;Cai Jianhua;Zhang Tongyi;Liu Meng;Wang Wei(Department of General Surgery,Huadong Hospital Affiliated to Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华东医院普通外科,上海200040

出　　处：《中华肝脏外科手术学电子杂志》2020年第1期46-49,共4页Chinese Journal of Hepatic Surgery(Electronic Edition)

摘　　要：目的探讨胆囊癌合并急性胆囊炎(AC)患者的诊断、治疗及预后。方法回顾性分析2009年1月到2019年1月复旦大学附属华东医院行手术治疗的21例胆囊癌合并AC患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男12例,女9例;平均年龄(65±12)岁;18例合并胆囊结石。根据胆囊炎症严重程度将其分为轻度组和中度组,分析胆囊炎症程度、手术方式等对生存的影响。生存分析采用Log-rank检验。结果13例术中冰冻病理检查确诊,另外8例为术后病理学检查确诊。行开腹胆囊癌根治术12例,腹腔镜胆囊切除术(LC)9例。术后病理分期示0-Ⅰ期3例,Ⅱ期6例,Ⅲ期11例,Ⅳ期1例。剔除Tis和T1a患者,轻度组中位生存期38个月,中度组18个月,轻度组总体生存率优于中度组(χ^2=5.615,P<0.05)。行胆囊癌根治术患者的中位生存期为25个月,LC患者为5个月,行开腹胆囊癌根治术患者的总体生存率优于LC患者(χ^2=8.412,P<0.05)。结论胆囊癌合并AC老年患者多发,胆囊炎症的严重程度和术式与预后相关。术中积极送冰冻病理学检查,建议非Tis和T1a患者行开腹胆囊癌根治术。Objective To investigate the diagnosis,treatment and prognosis of gallbladder carcinoma patients complicated with acute cholecystitis(AC).Methods Clinical data of 21 gallbladder carcinoma patients complicated with AC undergoing surgery in Huadong Hospital Affiliated to Fudan University from January 2009 to January 2019 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,12 patients were male and 9 female,aged(65±12)years on average.18 cases were complicated with cholecystolithiasis.According to the severity of gallbladder inflammation,all patients were divided into the mild and moderate groups.The effect of gallbladder inflammation severity and surgical approach upon the survival was evaluated.Survival analysis was conducted by Log-rank test.Results 13 cases were confirmed by intraoperative pathological examination,and the remaining 8 cases were confirmed by postoperative pathological examination.12 cases underwent open radical resection of gallbladder carcinoma and 9 received laparoscopic cholecystectomy(LC).Postoperative pathological staging indicated that 3 cases were diagnosed with stage 0-Ⅰgallbladder carcinoma,6 with stageⅡ,11 with stageⅢand 1 case with stageⅣ.Patients with stage Tis and T1a gallbladder carcinoma were excluded.In the mild group,the median overall survival was 38 months,significantly better compared with 18 months in the moderate group(χ^2=5.615,P<0.05).The median overall survival of patients undergoing open radical resection of gallbladder carcinoma was 25 months,significantly better than 5 months of those undergoing LC patients(χ2=8.412,P<0.05).Conclusions Gallbladder carcinoma complicated with AC is common in elderly patients.The severity of gallbladder inflammation and surgical approach are correlated with clinical prognosis.Intraoperative frozen pathological examination should be positively adopted.Open radical cholecystectomy is recommended for non-Tis and T1a stage patients.

关 键 词：胆囊肿瘤 胆囊炎 急性 外科手术 

分 类 号：R735.8[医药卫生—肿瘤] R575.61[医药卫生—临床医学]