原发性胆囊癌36例临床分析

目的探讨早期发现原发性胆囊癌及提高疗效的措施。方法对2004—2005年收诊的36例胆囊癌患者进行回顾性分析。结果本组术前确诊率为25.0%,手术治疗36例,术式包括胆囊切除、肝楔形切除4例,腹腔镜术中中转开腹行胆囊切除、胆管探查、区域淋巴结清扫2例,开腹胆囊切除、胆道探查、T管引流术11例,单纯胆囊切除术12例,开关术1例,开腹胆囊切除、胆道探查、Stent支架植入术2例,胆囊切除、肝楔形切除、胆道探查取石、T管引流术1例,胆囊切除、肝楔形切除、区域淋巴结清扫、胆总管空肠吻合术2例,胆囊切除、胆道探查取石、胆总管十二指肠吻合术1例。Nevin分期I期2例,II期3例,III期11例,IV期12例,V期8例。5年存活率为8.3%。结论目前临床发现的胆囊癌大部分为中、晚期,疗效较差。提高疗效的途径在于早期发现和处理胆囊癌的高危因素。强调病理检查对判断预后的重要性,手术治疗是最佳选择。

Clinical analysis for 36 cases of primary gallbladder cancer

Objective To investigate the measures of finding gallbladder cancer early and to improve the therapeutic effect on gallbladder cancer.Methods A retrospective clinical analysis was made in 36 patients with gallbladder cancer,who were admitted to the hospital between 2004 and 2005.Results Preoperative diagnostic rate was 25.0%(9/36).Among the 36 patients with gallbladder cancer who received operation,open cholecystectomy and liver wedge resection were 4 cases,and conversions to open cholecystectomy,exploration of common bile duct and regional lymphadonectomy were 2 cases,open cholecystectomy,exploration of common bile duct and T tube drainage were 11 cases,simple cholecystectomy was 12 cases,exploratory laparotomy was 1 case,open cholecystectomy,exploration of common bile duct and stent placement were 2 cases,open cholecystectomy,liver wedge resection,exploration of common bile duct,caculi removement and T tube drainage was 1 case,open cholecystectomy,liver wedge resection,regional lymphadonectomy and choledochojejunostomy were 2 cases,open cholecystectomy,exploration of common bile duct,caculi removement and choledochoduodenostomy was 1 case.According to Nevin staging,2 cases in stage I,3 cases in stage II,11 cases in stage III,12 cases in stage IV,8 cases in stage V.Follow-up revealed that 5-year survival rate was 8.3%(3/36).Conclusion Currently,most patients with gallbladder carcinoma are at middle and advanced period,so the therapeutic effect is not satisfactory.The way of enhancing therapeutic effect is to find and treat the high risk factors of gallbladder cancer early.The importance of pathological examination for the evaluation of prognosis should be emphasized and surgical operation is the best choice.