意外胆囊癌的外科处理

随着腹腔镜技术的普及,腹腔镜胆囊切除术中、术后发现的意外胆囊癌逐渐增多。高龄、结石病史等胆囊癌高危因素与意外胆囊癌相关;术中操作、人工气腹等原因可导致肿瘤的种植转移。胆囊癌外科治疗的关键在于早期发现,不同分期的胆囊癌应采用不同的手术方式,肿瘤的分期是最重要的预后因素。     

胆囊癌的积极外科处理

近年来胆囊癌（GC）发病率有所上升，随诊治技术的提高，其预后有所改善，本院从1992－1995年收治127例，现将有随资料的54例手术病人情况报道于下。     

胆囊癌的积极外科处理

日本Hamamatsu医学院在1978～1988年间共收治胆囊癌40例,女30例,男10例;平均年龄62.1岁(44～88岁).其中5例为尸解证实,35例术中确诊.作者指出,胆囊癌在早期和可切除阶段,因缺乏病理学依据和症状而难以发现.虽然,外科医师常对广泛侵及周围器官的晚期胆囊癌致力于积极的外科处理,但术后五年生存率极低.作者报告2例晚期胆囊癌,经广泛切除后现已分别存活7年8个月和8年5个月.因而认为,只要病人具备手术指征,对胆囊癌作积极外科处理是可以达到长期存活的.     

意外胆囊癌的预防与外科处理

意外胆囊癌是在胆囊良性疾病行胆囊切除术中或者术后病理检查意外发现的胆囊癌.由于胆囊癌早期无特异性诊断指标,且多伴随胆囊良性疾病,因此有相当一部分胆囊癌是意外发现的.随着我国腹腔镜胆囊切除术的普及,意外胆囊癌的发生也呈现增多趋势.临床工作中我们应该加强对意外胆囊癌的认识,警惕发生胆囊癌的危险因素,减少术前胆囊癌的漏诊,以...     

微创时代下意外胆囊癌的外科处理

意外胆囊癌（Unexpected gallbladder carcinoma,UGC）是指术前拟诊为胆囊良性疾病,在术中或术后偶然发现的胆囊癌.随着腹腔镜胆囊切除术（Laparoscopic cholecystectomy,LC）的广泛开展,UGC的发病率也在不断上升,文献报道为0.2％ ～2.8％.绝大部分术前评估为良性病变的UGC病例属T1和T2期的早期胆囊癌.手术切除是唯一能根治胆囊癌的治疗方式,根治性胆囊切除术是治疗胆囊癌的标准术式,目前胆囊癌手术方式的选择主要根据肿瘤的T分期,也就是肿瘤对胆囊壁侵犯的深度.但是目前关于UGC的外科处理还存在很多争论,没有形成统一的治疗规范.本文就临床工作中对于UGC诊疗中不可避免的几个问题进行探讨.     

我国胆囊癌的发病情况及外科处理

原发性胆囊癌的早期诊断与治疗是目前胆道外科迫切要解决的问题之一,结合全国七届胆道外科学术会议共收到胆囊癌３８７５例临床资料,对其发病情况、诊断与治疗进行了探讨。１发病情况我国胆囊癌在消化道肿瘤中居第五位,居胆道肿瘤首位,但目前尚缺乏胆囊癌发病率的大宗...     

早期胆囊癌

胆囊癌的预后不佳 ,手术切除率仅 2 0 %～ 4 0 %。Nevin提示患者的生存期与肿瘤的浸润深度密切有关 ,所谓早期胆囊癌多在其他手术时偶被发现的。印度Sanjay Gandhi医科院外科等单位于 1989～ 1999年曾收治 35 0例胆囊癌 ,其中 14 1例施行手术切除。重点分析 14例 p T1期胆囊癌。全组 14例中 ,2例属 p T1a期 (粘膜层肿瘤 ) ,12例为 p T1b期 (肌层肿瘤 )。患者平均年龄 6 0岁 (40～ 76岁 ) ,男 5例 ,女 9例。3例在术前作出诊断 ,另 3例在手术中作出诊断 ,8例是由病理检查中发现的。术前诊断者均在超声扫描发现胆囊隆起病变 ,位于底部 2例和…     

胆囊癌累及肝门部胆管的外科处理

根据２６例胆囊癌累及肝门部胆管的外科治疗经验，探讨其手术治疗的价值。方法：２１例行肿瘤切除，其中８例行ＨＰＤ，１２例行胆囊加肝部分及肝门部胆管切除，１例行胆囊加肝部分切除，另５例因肿瘤广泛转移而公行外引流。结果；手术均顺利完成，其中２１例随访２－３４个月，仍存活１５例，其中２例已存活２年以上，１例术后１周死于ＭＯＦ，５例于术后生存３－１５个月。     

A rare case of early carcinoma of the gallbladder

A 38-year-old woman was diagnosed preoperatively to have a benign polyp of the gallbadder with a delineated polypoid mass, as demonstrated with drip infusion cholangiography and ultrasonography. Cholecystectomy was performed. Postoperatively, however, this tumor proved to be an early stage carcinoma of the gallbladder. In the neck of the gallbladder, there was a protruded polypoid elastic tumor of 1.1×0.9 cm in width and 2.5 cm in height. The tumor was supported by a stem of 0.1 cm in diameter and 0.2 cm in height. Hispotopathological examination revealed a well differentiated papillotubular adenocarcinoma, which exhibited no invasion of the stem itself or its basal region. This is a rare case of early carcinoma of the gallbladder (Stage I) which grew only towards the lumen of the gallbladder cavity, and did not invade the wall. Postoperatively, cholecystectomy alone was thought to be sufficient for cure.     

Seeding from early stage gallbladder carcinoma after laparoscopic cholecystectomy

In the last years laparoscopic cholecystectomy has become the "gold standard therapy" in the treatment of symptomatic cholelitiasis, but it is necessary to keep into account some problems and risks that can arise from laparoscopic technique. One of these risks is represented surely by the disregarding of a gallbladder carcinoma. The authors report a case of peritoneal seeding of an unsuspected gallbladder carcinoma following laparoscopic cholecystectomy. The first histologic diagnosis was chronic ulcerous cholecystitis with adenomiosis but 2 months later the metastasis developed at the umbilical port site, at another port site and to the right lobe of the liver. Another histological sampling of the gallbladder specimen was performed and this time a little intra mucous gallbladder adenocarcinoma was found (T1 stage). While the most part of literature data concern advanced stage of the disease at the time of operation (T2, T3) only few reports regard early stage neoplasm. Therefore this risk is present not only in advanced stages of gallbladder carcinoma but even in cases of early stage cancers. After a laparoscopic cholecystectomy all specimen should be opened and inspected. If there is a gallbladder wall irregularity and if there was a bile spillage it is advisable to perform a preoperative histologic examination.     

Ultrasonographic detection of early and curable carcinoma of the gallbladder

Five patients with early carcinoma of the gallbladder detected by ultrasonography were studied. Three complained of non-specific upper abdominal symptoms or were asymptomatic and two had severe biliary colic. Gallstones were present in the two patients without biliary symptoms. Early carcinoma of the gallbladder was demonstrated as a polypoid tumour by ultrasound in four patients and as thickening of the gallbladder wall in one. The tumour was over 2 cm in diameter in all but one patient in whom the tumour enlarged rapidly from 5 to 10 mm. Size of the tumour and extent of spread were closely related. All but one patient underwent curative resection. Ultrasonography enhances the detection of early carcinoma of the gallbladder especially in old patients with non-specific abdominal symptoms and the operative cure rate is thereby improved.     

意外早期胆囊癌的手术治疗与预后分析

目的 探讨意外发现的早期胆囊癌的治疗方法与预后.方法 回顾性总结1995年7月至2005年7月我院收治的24例意外早期胆囊癌临床病理资料,对其治疗方法及影响预后的因素进行分析.结果 24例术中快速冰冻切片或术后病理切片证实为早期胆囊癌(Nevin Ⅰ~Ⅱ期).7例于术中施行了标准的根治术,10例术后确诊再行根治,7例行单纯胆囊切除术.多因素分析表明,组织学分级、Nevin分期及手术方式是影响预后的独立因素;再次行根治手术组生存率与即刻行根治手术组比较无统计学差异,单纯胆囊切除术组与胆囊癌根治术组患者的生存率差异有统计学意义.结论 早期胆囊癌术前诊断困难,术中对可疑者做快速冰冻切片检查有助于发现早期胆囊癌;一旦确诊即予施行根治术,术后病理明确者亦应再行根治手术.     

进一步做好胆囊癌的早期诊断

回顾百余年的历史,人们对胆囊癌认识和诊治研究水平有了长足的进步。由于该病发病隐匿,恶性程度高,预后极差而备受关注,虽然对中晚期病例采用了一些积极治疗措施,总体水平仍不尽人意。当前早期诊断依然是关键性问题。一、早期诊断的意义临床上所发现的早期病例多为良性疾患行胆囊切除术,病检诊断为胆囊癌,多为Nevin I或Ⅱ期,病人获得长期无瘤生存。随着影像学技术检查的普及和健康查体的推广,早期病例发现有所增加,文献报道这类病人根治术后5年生存率可达90%～100%,而晚期病人不足5%。至今大量临床资料报道,多数病人在术前明确诊断时多为中…     

Incidental gallbladder carcinoma

Carcinoma detected at histological examination of the gallbladder is defined as incidental. It is a fairly rare event, but the increase in the number of cholecystectomies performed has led to a rise in detection of incidental gallbladder carcinoma. Histologically, in most cases, these are pT1 and pT2 carcinomas. Up until the 'nineties it was believed that these carcinomas could be adequately treated by simple cholecystectomy, whereas today the treatment of choice entails a second operation. This study constitutes a review of 20 years' experience. The database consists of 3012 cholecystectomies. Survival data are calculated in relation to the evolution of surgical treatment, thus making it possible to correlate tumour staging, patient survival and surgical therapy. The incidence of IGC was about 0.66% (20 cases). The survival rates of patients operated on by extended cholecystectomy, compared with those achieved previously with simple cholecystectomy, have risen from 92% to 100% at 1 year and from 26% to 66% at 5 years, respectively. The contributions made by literature reports since the 'nineties have prompted hepatobiliary surgeons to modify their attitudes towards incidental gallbladder carcinoma. Detection of previously unrecognised microinfiltrations of the serosa and of neoplastic involvement of distant lymph-node stations has led to the introduction of the concept of extended cholecystectomy. Comparison between our historical survival curve of patients treated with simple cholecystectomy and the distinctly better curve of those treated with a radical second operation accounts for the evolution of surgical treatment over the past two decades.     

Management of unsuspected gallbladder carcinoma discovered during or following laparoscopic cholecystectomy

Laparoscopic cholecystectomy (LC) is widely used in the treatment of symptomatic cholelithiasis. Gallbladder carcinoma (GBC) discovered during or after LC presents a management problem because of the difficulty of intraoperative staging. We conducted a retrospective, 8-year review of 10 patients with GBC discovered during or after LC. Of 3050 patients undergoing LC for cholelithiasis, 10 (0.3%) had GBC. The histological diagnoses of the 10 GBC patients included well-differentiated adenocarcinomas (n = 5), papillary adenocarcinomas (n = 2), moderately differentiated adenocarcinomas (n = 2), and poorly differentiated adenocarcinoma (n = 1). Of these patients, four had TNM classified T1 tumors, three had T2 tumors, one had T2N0M0 tumor, one had T2N1M0 tumor, and one had T3N0M0 tumor. In three of them (T2N0M0, T2N1M0, and T3N0M0), the procedure was converted to open cholecystectomy, wedge resection of liver bed tissue in segment 5, and lymph node dissection after frozen-section biopsy of the laparoscopically removed gallbladder revealed GBC. Patients were closely followed at regular intervals until death or May 2000. The median follow-up period was 24.5 months. One patient died of carcinomatosis 6 months after undergoing the open procedure. The remaining nine patients did not have any recurrence during the follow-up period. No patient had a port site recurrence of GBC. Based on our limited experience, early GBC (T1a or T1s) can successfully be managed by simple cholecystectomy, either by LC or the open method.     

Advanced carcinoma gallbladder

Gallbladder cancer is a relatively rare form of malignancy. As yet, the progress in its management is very slow, which leads to high mortality and very low survival. There is a dire need to help this class of patients by bringing in resources to find ways to reduce its dismal prognosis. At present, the best chances for this disease are early radical surgery. But in patients with invasion of adjacent organs, extended surgery, excising the invaded tissue, may be justified. In patients with distant lymph-node metastasis, even without adjacent organ invasion, radical surgery may not achieve a good outcome.1 Here, combination chemotherapy or chemo-radiotherapy may have some benefits.     

原发性胆囊癌

目的探讨胆囊癌的早期诊断及各种手术对其预后的影响。方法对５６例胆囊癌患者的致病因素进行分析。结果按照Ｎｅｖｉｎ分期Ⅰ期５例,Ⅱ期７例,Ⅲ期１０例,Ⅳ期１３例,Ⅴ期１０例。行各类切除性手术３２例（５７１％）,剖腹探查取活检１３例（２３２％）,非手术行放疗或化疗１１例（１９７％）。各类切除性手术的１,３,５年生存率分别为５６３％（１８／３２）,２８１％（９／３２）,１２５％（４／３２）,探查活检的１３例及非手术治疗的１１例均在明确诊断后５个月内死亡。结论早期诊断和及时行根治性手术是改善胆囊癌预后的关键     

原发性胆囊癌的早期诊断问题

决定原发性胆囊癌预后的首要因素是病期 ,早期诊断是提高疗效的最重要环节。一般认为 ,NevinⅠ或Ⅱ期的病例可属于早期胆囊癌 ,以下从几个方面阐述早期诊断的有关问题。1　临床表现原发性胆囊癌起病隐匿 ,无特异性表现 ,但并非无规律可循 ,按出现频率由高至低临床表现依次为腹痛、恶心、呕吐、体重减轻和黄疸等。临床上可将其症状群归为五大类疾病的综合表现[1] :①急性胆囊炎 :某些病例有短暂的右上腹痛、恶心、呕吐、发热和心悸病史 ,提示急性胆囊炎。约 1%因急性胆囊炎手术的病例有胆囊癌存在 ,此时病变常为早期 ,切除率高 ,生存期长。…