58 例原发性胆囊癌的临床诊治分析简

目的 探讨原发性胆囊癌的临床诊断,手术方式选择及预后.方法 对我院2005-06~2012-06间收治的58例原发性胆囊癌患者的临床资料进行回顾性分析.结果 术前彩超检查诊断符合率为79.3%（46/58）;术前CT检查诊断符合率为87.2%（34/39）;术前MRI和MRCP检查诊断符合率为77.8%;血清CA19-9及CEA阳性率分别为71.8%（28/39）和61.5%（24/39）.根据TNM分期标准,本组Ⅰ期3例,Ⅱ期9例,Ⅲ期17例,Ⅳ期29例.58例患者均行手术治疗,18例行单纯胆囊切除术,其中3例Ⅰ期患者获长期生存.18例行根治性切除术,根治性切除率为31%.58例病人中有45例获得随访,随访率为77.6%.其中随访的6例Ⅱ期患者及3例Ⅲ期患者术后生存期超过3年;3例Ⅱ期患者术后生存期超过5年;3例Ⅳ期患者术后分别生存16个月、20个月、21个月.结论 术前影像学的联合检查可提高诊断的准确率,早期诊断和根治性手术是提高胆囊癌患者生存率的有效方法.

58 Clinical Diagnosis and Treatment Cases of Primary Gallbladder Carcinoma

Objective To explore the clinical diagnosis, surgical options and prognosis of primary carcinoma of gallbladder （PCG）. Methods A retrospective analysis was performed for 58 cases of primary carcinoma of gallbladder, who received treatment from June, 2005 to June, 2012 in Heilongjiang Provincial Hospital. Results The preoperative localization accuracy of Color Doppler ultrasound and compu- ted tomography（CT） was 79. 3% （46/58） and 87. 2% （34/39）, the preoperative localization accuracy of Magnetic Resonance Imaging （MRI） and Magnetic Resonance Cholangiopancreatography （MRCP）was 77. 8% , and positive rate of serum CA19 -9 and CEA was 71.8% （28/39） and 61.5% （24/39） respectively. In accordance with TNM staging criteria, there were 3 cases in Ⅰ stage,9 cases in Ⅱ stage, 17 cases in Ⅲstage,29 cases in IV stage. All 58 patients underwent operation treatment ：18 patients performed cholecystectomy alone, and among these patients 3 with Ⅰ stage obtained long term survival. 18 cases underwent radical excision, and the rate of radical excision was 31%. 45 of the 58 patients have been followed - up,and follow - up rate was 77. 6%. 6 patients with Ⅰ stage and 3 patients with Ⅲ stage received operation survived over 3 years. 3 patients with II stage postoperative survival time exceeded 5 years. 3 cases with Ⅳ stage performed extended radical gallbladder surgery,their survival times were 16, 20 and 21 months respectively. Conclusion Preoperative imageological associated examination may improve diagnostic rate. Early diagnosis and radical operation are effective methods for improving survival rate of patients suffering primary carcinoma of the gallbladder.