TNM分期在胆囊癌根治性切除术中地位和作用  

The status and role of TNM staging in radical resection of gallbladder carcinoma

作　　者：钱昌林[1] 刘颖斌 QIAN Chang-lin;LIU Ying-bin(Department of General Surgery,South Hospital of Shanghai Renji Hospital Affiliated to Medical College of Shanghai Jiao-tong University,Shanghai 200127,China;不详)

机构地区：[1]上海交通大学医学院附属仁济医院南院普外科,上海201112 [2]上海交通大学医学院附属仁济医院胆胰外科,上海市肿瘤研究所(癌基因与相关基因国家重点实验室)上海市胆道疾病研究重点实验室,上海市胆道疾病研究中心,上海200127

出　　处：《中国实用外科杂志》2022年第9期1046-1050,共5页Chinese Journal of Practical Surgery

基　　金：上海市科委基础重点项目(No.20JC1419101)。

摘　　要：胆囊癌是胆道系统常见的肿瘤,易发生血行、淋巴结及远处转移,外科根治性手术的完成比例不高,是胆囊癌病人生存率较低的原因。对于T1a期胆囊癌病人,目前主要以行腹腔镜胆囊切除术为主。对于T1b期肿瘤需要慎重对待,楔形肝脏切除联合区域淋巴结清扫可能尚未达到根治性切除的目的。对于T2期胆囊癌病人应重点强调区域淋巴结的清扫彻底和清扫质量。对于T3期以上的病人,更需重视R0切除的完成,在充分术前评估的情况下,半肝切除、右三肝切除及联合器官切除均可在考虑范围之内。借助精准化的胆道外科理念,合理的运用TNM分期,规范化胆囊癌的认识、诊断及治疗,完善胆囊癌根治术的范围策略,有望达到胆囊癌R0切除的目标,努力提高胆囊癌病人的生存率。Gallbladder cancer is a common tumor of biliary system,prone to hematogenous,lymph node and distant metastasis,and the proportion of radical surgical procedures completed is not enough,which is the reason for the low survival rate of gallbladder cancer.For patients with stage T1a gallbladder cancer,laparoscopic cholecystectomy is currently the main method.T1b tumors need to be treated with caution,and wedge-shaped liver resection combined with regional lymph node dissection may not achieve the objective of radical resection.For patients with T2 gallbladder cancer,the thorough and quality of regional lymph node dissection should be emphasized.For patients with stage T3 and above,more attention should be paid to the completion of R0 resection.Under the circumstance of adequate preoperative evaluation,hemihepatectomy,right trihepatic resection,and combined organ resection can all be considered.With the help of a precise biliary surgical concept,the rational use of TNM staging,standardization of the understanding,diagnosis and treatment of gallbladder cancer are expected to achieve the scope and strategy of radical resection of gallbladder cancer,achieved the goal of R0 resection of gallbladder cancer,and strive to improve the survival rate of gallbladder cancer patients.

关 键 词：胆囊癌 根治性切除 TNM分期 

分 类 号：R6[医药卫生—外科学]