胆囊结石快速进展为胆囊癌病例1例

胆囊癌早期无特征性变相，症状易被胆石症、胆囊炎临床表现所掩盖，多数患者在行胆囊切除术中或术后病理检查时才确诊为胆囊癌。本文报道1例有影像学资料记录胆囊结石快速进展为胆囊癌的前后变化。探讨胆囊癌的发生机制及其高危因素和治疗。     

原发性胆囊癌48例临床病理特征分析

目的探讨原发性胆囊癌的病因及特点。方法对48例原发性胆囊癌临床病理资料进行回顾性分析。结果本组中男性18例，女性30例(62．5％)，男女之比1：1．67。60岁以上40例(83．3％)。合并胆囊结石35例72．9％。结论原发性胆囊癌好发于60岁以上的女性，与结石刺激有关。     

胆囊结石并存胆囊癌5例临床分析

我院1986～1996年共手术治疗胆囊结石212例,其中病理证实并存胆囊癌5例,占2.35%.分析报道如下. 1临床资料     

宁夏回汉族胆囊癌患者94例临床分析

目的：总结胆囊癌的诊治经验，了解回、汉族胆囊癌的临床差异。方法：回顾性分析我院1980年3月至2000年7月间收治的当地回、汉族胆囊癌患者94例，结合文献进行讨论。结果：胆囊癌在汉族中较回族中多见，并存结石发生率(均高)相近，均以老年女性多见。临床表现为腹痛、黄疽和腹部肿块等。CT诊断阳性率较高。早期患者手术切除率高，生存期长。结论：胆囊癌汉族较回族多见，可能与胆石症有关；尽可能切净癌肿组织，可以取得一定效果。     

宁夏回汉族胆囊癌患者94例临床分析

目的：总结胆囊癌的诊治经验，了解回、汉族胆囊癌的临床差异。方法：回顾性分析我院1980年3月至2000年7月间收治的当地回、汉族胆囊癌患者94例，结合文献进行讨论。结果：胆囊癌在汉族中较回族中多见，并存结石发生率（均同）相近，均以老年女性多见。临床表现为腹痛、黄疸和腹部肿块等。CT诊断阳性率较高。早期患者手术切除率高，生存期长。结论：胆囊癌汉族较回族多见，可能与胆石症有关；尽可能切净癌肿组织，可以取得一定效果。     

原发性胆囊癌误诊分析

目的分析原发性胆囊癌误诊原因,探索有效的预防措施。方法我院1995年1月至2006年5月共收治原发性胆囊癌患者46例,对其临床资料进行回顾性分析。结果术前明确诊断14例(占30.4%)。误诊32例(占69.6%),术中误诊6例(占13.0%)。合并胆囊结石者18例(占39.1%),胆囊息肉样病变8例(占17.4%)。术前诊断为胆囊结石、胆囊炎21例(占45.7%)。超声检查阳性率43.5%,CT检查阳性率66.7%,螺旋CT增强检查阳性率83.3%。结论误诊原因并发胆囊其它疾病;缺乏特异性临床表现,对发病情况认识不足;过分依赖影像学检查;术中对可疑病灶未做冰冻病理检查。预防措施熟悉胆囊癌的临床特点;可疑病例术前需完善检查;积极手术治疗癌前病变;术中可疑病灶应做冰冻病理检查。     

胆囊癌39例临床分析

目的：探讨胆囊癌的病因及诊断与治疗。方法：回顾分析39例胆囊癌病人的临床资料。结果：39例胆囊癌病人存在右上腹疼痛占100%,以B超检查作为首选检查方法,胆囊病人89.74%伴有胆囊炎、胆囊结石,手术治疗仍为最理想的治疗方法。结论：重视胆囊炎、胆囊结石、胆囊癌患者的早期诊断,早期治疗,探索新的治疗方法是外科医生需要努力的方向。     

原发性胆囊癌外科治疗(附34例分析)

目的:探讨胆囊癌的临床特点和提高疗效的途径。方法:对我院8年来收治的34例胆囊癌患者临床资料进行分析。结果:胆囊癌多见于中老年人,平均年龄64.61岁,34例患者中男12例,女22例,男女之比为1:1.83,胆囊癌合并胆囊结石者占65.71%,术前B超诊断符合率为82.14%。手术切除率为73.53%,根治性切除10例,根治率40%。1、3、5年生存率分别为58.82%、8.82%、2.94%。结论:B超、CT是常用的诊断方法,对易患胆囊癌高危人群应进行定期观察。手术方式及治疗效果取决于胆囊癌的分期。     

Risk factors for gallbladder cancer: A case–control study

Risk factors for gallbladder cancer (GBC) except gallstones are not well known. The objective was to study the risk factors for GBC. In a case–control study, 200 patients with GBC, 200 healthy controls and 200 gallstones patients as diseased controls were included prospectively. The risk factors studied were related to socioeconomic profile, life style, reproduction, diet and bile acids. On comparing GBC patients (mean age 51.7 years; 130 females) with healthy controls, risk factors were chemical exposure [odd ratios (OR): 7.0 (2.7–18.2); p < 0.001)], family history of gallstones [OR: 5.3 (1.5–18.9); p < 0.01)], tobacco [OR: 4.1 (1.8–9.7); p < 0.001)], fried foods [OR: 3.1 (1.7–5.6); p < 0.001], joint family [OR: 3.2 (1.7–6.2); p < 0.001], long interval between meals [OR: 1.4 (1.2–1.6); p < 0.001] and residence in Gangetic belt [OR: 3.3 (1.8–6.2); p < 0.001]. On comparing GBC cases with gallstone controls, risk factors were female gender [OR: 2.4 (1.3–4.3); p = 0.004], residence in Gangetic belt [OR: 2.3 (1.2–4.4); p = 0.012], fried foods [OR: 2.5 (1.4–4.4); p < 0.001], diabetes [OR: 2.7 (1.2–6.4); p = 0.02)], tobacco [OR 3.8 (1.7–8.1); p < 0.001)] and joint family [OR: 2.1 (1.2–3.4); p = 0.004]. The ratio of secondary to primary bile acids was significantly higher in GBC cases than gallstone controls (20.8 vs. 0.44). Fried foods, tobacco, chemical exposure, family history of gallstones, residence in Gangetic belt and secondary bile acids were significant risk factors for GBC.     

Geographic variation of gallbladder cancer mortality and risk factors in Chile: a population-based ecologic study

Chile's gallbladder cancer rates are among the highest in the world, being the leading cause of cancer deaths among Chilean women. To provide insights into the etiology of gallbladder cancer, we conducted an ecologic study examining the geographical variation of gallbladder cancer and several putative risk factors. The relative risk of dying from gallbladder cancer between 1985 and 2003 was estimated for each of the 333 Chilean counties, using a hierarchical Poisson regression model, adjusting for age, sex and geographical location. The risk of gallbladder cancer mortality was analyzed in relation to region, poverty, Amerindian (Mapuche) population, typhoid fever and access to cholecystectomy, using logistic regression analysis. There were 27,183 gallbladder cancer deaths, with age and sex-adjusted county mortality rates ranging from 8.2 to 12.4 per 100,000 inhabitants. Rates were highest in inland and southern regions. Compared to the northern-coast, the northern-inland region had a 10-fold risk (95% of confidence interval (95% CI): 2.4-42.2) and the southern-inland region had a 26-fold risk (95% CI: 6.0-114.2). Independent of region, other risk factors for gallbladder cancer included a high Mapuche population (Odds ratio (OR):3.9, 95% CI 1.8-8.7), high typhoid fever incidence (OR:2.9, 95% CI 1.2-6.9), high poverty (OR:5.1, 95% CI 1.6-15.9), low access to cholecystectomy (OR:3.9, 95% CI 1.5-10.1), low access to hospital care (OR:14.2, 95% CI 4.2-48.7) and high urbanization (OR:8.0, 95% CI 3.4-18.7). Our results suggest that gallbladder cancer in Chile may be related to both genetic factors and poor living conditions. Future analytic studies are needed to further clarify the role of these factors in gallbladder cancer etiology.     

胆囊疾病与大肠癌发生的关联性分析

目的 在大肠癌患者中,发现伴有胆囊结石及胆囊切除(简称胆囊疾病)的现象较常见.本研究旨在探讨胆囊疾病与大肠癌发生之间的关系.方法 回顾性收集2010-01-01-2014-12-31新疆医科大学附属肿瘤医院收治的1 514例大肠癌患者的资料作为大肠癌组;健康对照组是从同一时期在新疆医科大学附属肿瘤医院体检中心进行体检的健康人群中选取,采用系统抽样的方法,随机抽取1 523例健康人群作为健康对照.两组资料进行回顾性分析,观察两组合并胆囊疾病的发生情况,以及大肠癌组中,有胆囊疾病的患者与无胆囊疾病患者在年龄、性别、民族、糖尿病、甘油三酯、吸烟、饮酒、体质指数(body mass index,BMI)和肿瘤发生部位等各因素之间的差异.结果 1)大肠癌组合并胆囊结石及胆囊切除的病例分别为81例(30.2％)和187例(69.8％);健康对照组合并胆囊结石及胆囊切除的病例分别为44例(40.0％)和66例(60.0％),两组相比,差异有统计学意义(x2 =52.239,P＜0.001;x2 =22.747,P＜0.001).2)多因素分析显示,伴有胆囊疾病的合并有甘油三酯异常(x2 =4.205,P=0.040)、糖尿病(x2=10.807,P=0.001)、年龄≥60岁(x2=4.954,P=0.026)等因素是大肠癌发生的独立危险因素,且以右半大肠癌为高发(x2=24.634,P=0.000),但与性别(x2 =0.591,P=0.442)、民族(x2=0.027,P=0.870)、BMI(x2=3.550,P=0.060)、吸烟(x2=0.912,P=0.339)、饮酒(x2 =1.781,P=0.182)等因素无关.结论 大肠癌患者患有胆囊结石及胆囊切除的概率较健康组高,胆囊结石及胆囊切除可能是大肠癌发生的高危因素,尤其是右半结肠癌的发生;≥60岁、伴有糖尿病以及甘油三酯异常且合并胆囊疾病者发生大肠癌的风险明显升高.     

Association of chili pepper consumption,low socioeconomic status and longstanding gallstones with gallbladder cancer in a Chilean population

We explored the risk factors for gallbladder cancer and explanations for its sharp and constant incidence increase in Chile since the 1970s. We compared 114 consecutive patients with verified gallbladder cancer, diagnosed 1992-1995, to 114 matched hospital patients with gallstones, using conditional logistic regression analysis. Low education showed a nonsignificant positive relationship with gallbladder cancer [odds ratio (OR) = 2.3, 95% confidence interval (CI) 0.8-6.2], and low socioeconomic level showed a significant relationship (OR = 5.0, 95% CI 1.5-17.3). A very long history of gallstone disease was significantly more prevalent among cases (OR = 11.0, 95% CI 1.4-85.2). Significant red chili pepper consumption was observed in gallbladder cancer patients (OR = 2.9, 95% CI 1.6-5.2). Low intake of both fresh fruit and sugar as soft drinks was associated with gallbladder cancer, with ORs of 6.4 (95% CI 1.4-30.3) and 3.6 (95% CI 1.3-10.1), respectively. Multivariate analysis kept only a very low socioeconomic status and red chili pepper consumption as significant independent risk factors for gallbladder cancer, ORs of 6.3 (95% CI 1.7-23.0) and 3.2 (95% CI 1.7-5.9). Longstanding gallstone cases were removed from the multivariate model because all were in the low and very low socioeconomic groups, reinforcing the association. Patients with gallbladder cancer differed from matched controls by exhibiting lower socioeconomic levels, having a much longer history of gallstone disease and presenting a dietary pattern characterized by high red chili pepper consumption and low fresh fruit intake.     

Occult pancreaticobiliary reflux in gallbladder cancer and benign gallbladder diseases

BACKGROUND AND OBJECTIVES: It was proposed that occult pancreaticobiliary reflux (OPBR) was associated with precancerous mucosal changes in the gallbladder, hence the importance of this disorder. There are no published reports investigating the incidence of OPBR in patients operated on for the entire spectrum of benign gallbladder diseases and gallbladder cancer. Our aim was to determine the incidence of OPBR and measure the levels of active pancreatic enzymes (amylase and lipase) in gallbladder bile of patients undergoing cholecystectomy for benign and malignant gallbladder diseases. METHODS: One hundred eight patients with normal pancreaticobiliary junction evidenced by operative cholangiography were included in the study. RESULTS: According to gallbladder bile amylase and lipase levels, 84.2% and 89% patients respectively had OPBR. OPBR was present in all gallbladder cancer patients; in these patients the biliary levels of amylase and lipase were significantly higher than the levels found in patients with benign gallbladder pathology (P < 0.0001). CONCLUSIONS: OPBR could lead to inflammatory changes of the biliary epithelium and progress towards the development of precancerous mucosal changes and gallbladder cancer. The reason why such high levels of pancreatic enzymes are regurgitated into the biliary tree of patients with gallbladder cancer should be clarified.     

高血糖与胆囊癌浸润转移的关系

目的 流行病学调查显示糖尿病患者中胆囊癌的发病率显著增高.本研究通过对胆囊癌高血糖组和胆囊癌血糖正常组临床病理特征的分析和血清学指标的检测,探讨高血糖与胆囊癌浸润转移的关系.方法 选取2010-04-01-2015-04-15广西医科大学第一附属医院诊治的住院胆囊癌患者233例,按照空腹血糖分为血糖正常组128例(3.9 mmol/L≤血糖＜6.1 mmol/L)和高血糖组105例(≥6.1 mmol/L).分别比较两组患者的肿瘤相关血清学指标(AFP、CEA、CA125、CA19-9、CA15-3)和各项临床病理特征(肿瘤分化程度、淋巴结转移、静脉癌栓、远处脏器转移、Nev-ein分期).结果 胆囊癌高血糖组与胆囊癌血糖正常组相比,高血糖组低分化或未分化癌发生的比率,以及淋巴结转移、静脉癌栓和远处脏器转移发生的比率均高于血糖正常组,差异有统计学意义,x2分别为11.288、9.117、14.224和11.797,均P＜0.05;高血糖组高分化癌发生的比率低于血糖正常组,差异有统计学意义,x2=25.010,P＜0.05;高血糖组和血糖正常组在中分化癌发生的比率及Nevein分期Ⅰ或Ⅱ期(即早期)所占比率差异无统计学意义,x2=0.023,P＞0.05;高血糖组和血糖正常组血清中甲胎蛋白(alpha fetoprotein,AFP)、癌胚抗原(carcino-embryonic antigen,CEA)、糖蛋白抗原CA125、糖蛋白抗原CA19-9、糖蛋白抗原CA15-3的浓度均差异无统计学意义,Z值分别为-0.379、-1.125、-1.360、-1.391和-1.701,均P＞0.05.对胆囊癌血糖正常/异常的相关因素进行Logistic回归分析,纳入方程的自变量有高分化、中分化、低分化和淋巴结转移.其中低分化和淋巴结转移是危险因素,与胆囊癌伴高血糖正相关,但由于OR值较小,是低度相关危险因素.结论 高血糖能促进胆囊癌的浸润和转移,尽早将血糖控制在正常范围,将改善合并高血糖的胆囊癌患者的预后.     

胆囊癌的超声诊断现状及新进展

胆囊癌是胆道系统最常见的恶性肿瘤之一,早期缺乏特异性就诊时已属中晚期,预后差.胆囊癌目前最常用的检查方法是二维超声和彩色多普勒超声,近几年随着超声新技术的发展,尤其超声造影(ultrasonic contrast,CEUS)的运用大大提高了胆囊癌的早期诊断率.本文就超声检查方法在胆囊癌诊断中的应用现状和最新进展作一综述.