原发性胆囊癌41例误诊原因分析

目的 探讨原发性胆囊癌的误诊原因，寻找预防的方法。方法 回顾性分析1985至2002年41例术前未确诊或疑诊而术后病理诊断为原发性胆囊癌的临床资料。结果 术前诊断为胆囊结石25例、急性胆囊炎2例、萎缩性胆囊炎6例、胆囊息肉2例，胰头癌2例、总胆管结石2例、上消化道穿孔l例、肝癌l例。结论 要提高警惕，增加对原发性胆囊癌发病率上升的认识，加强对高危人群的监测，认识到B超检查的局限性；必要时术中冰冻切片检查，亦可提高胆囊癌的诊断率。     

原发性胆囊癌18例误诊分析

目的:探讨原发性胆囊癌的误诊原因.方法: 回顾性分析我院经手术治疗、病理证实的误诊原发性胆囊癌18例.结果: 本组共18例,其中女12例、男6例,平均年龄67.0岁,误诊为慢性胆囊炎或胆囊结石10例,胆囊息肉8例 .结论: 通过18例胆囊患者的诊治分析,对胆囊癌误诊原因作了进一步阐述,并提出有效的治疗方法,取得了一定的临床效果.     

中晚期胆囊癌手术方式的临床分析

目的：探讨中晚期胆囊癌手术方式与预后关系。方法：回顾性分析1997年1月至2005年1月间收治的85例中晚期胆囊癌的临床资料，施行胆囊癌根治性切除术40例，扩大根治术25例，姑息性手术20例。结果：均获得病理诊断，腺癌51例（60％），最为常见。65例行根治术＋扩大根治术和85例总的术后的1年、3年、5年生存率分别为80．0％、61．5％、49．2％；67．1％、47．1％、37．6％。结论：胆囊癌根治术＋扩大根治术是提高中晚期胆囊癌切除率和疗效的有效方法。     

胆囊癌合并肝门胆管侵犯22例手术治疗体会

胆囊癌恶性程度较高，常直接侵犯或经淋巴转移累及周围脏器，就诊时多数已属NevinⅣ、Ⅴ期，合并肝门胆管侵犯者并不少见，切除胆囊病灶、受累肝叶及区域淋巴清扫已得到广泛认同。对病变范围较广泛的患者如何治疗，学者们的观点不一，而胆囊癌导致的梗阻性黄疸迄今仍常常被当作“已丧失手术治疗机会”的标志之一。近年来，随着辅助检查方法、     

原发性胆囊癌41例诊治体会

作者报告１９８６年至１９９６年间手术治疗并经病理诊断的４１例原发性胆囊癌，着重分析了影响早期发现胆囊癌的各种有关因素。作者认为，对本病应有足够的认识，联合应用多种检查方法是提高早期诊断率的有效手段，术中应重视对胆囊标本的检查。     

原发性胆囊癌11例误诊原因及治疗方法

目的 探讨原发性胆囊癌的误诊原因及临床诊断治疗方法。方法 收集本院10年间所进行276例胆囊切除术中，最终病理确诊11例胆囊癌资料进行分析，结果 11例病例占同期胆囊切除术的3．9％。其中有8例并发胆囊结石，l例术前诊为胆囊息肉伴慢性胆囊炎，2例术前考虑胆囊癌。结论 通过11例胆囊癌患的诊治分析，对胆囊癌误诊原因作了进一步阐述，并对晚期胆囊癌姑息治疗作了探讨。提出用Y型胶管胆管十二指肠搭桥内引流的简易方法，并取得了一定的临床效果。     

原发性胆囊癌误诊原因分析

1985年1月~1997年5月我院共收治原发性胆囊癌61例,误诊率60.65%(37/61)。现报告如下。1.临床资料1.1 一般情况:男13例,女24例,年龄50~79岁,平均58岁。1.2 临床症状:病程1月~10年,右上腹部胀痛33例,上腹部包块5例,黄疸4例,食纳下降8例,恶心呕吐4例。     

原发性胆囊癌11例诊断体会

原发性胆囊癌并不少见,早期无特殊临床表现,一旦发现,多为晚期,严重影响治疗和预后,应得到临床上的重视。我们1978年5     

原发性胆囊癌35例分析

目的　探讨胆囊癌诊治方法 ,提高胆囊癌疗效。方法　对 1991年 1月～ 2 0 0 0年 12月收治的 35例胆囊癌患者的临床资料进行综合分析。结果　 35例中 ,男 18例 ,女 17例 ,男女之比为 1 0 6∶1。 5 0岁以上者 2 9例 ,占 82 86%。B超、CT确诊率分别为37 0 5 % ( 12 /32 )、64 2 9% ( 18/2 8)。 35例中 2 7例手术探查 ,切除 13例 ,切除率 48 15 % ,其中根治性切除 9例 ,根治率 33 33%。 2 7例手术者获随访 2 1例 ,随访率 77 78%。 5 9 2 6%的患者于术后 1年内死亡。结论　临床发现的胆囊癌大部分仍属中晚期 ,疗效不佳。提高疗效的关键在于早期发现和积极治疗胆囊癌高危病变     

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。     

原发性胆囊癌28例临床分析

目的 探讨原发性胆囊癌的诊断.方法 回顾性分析该院2002年4月至2007年8月收治的经手术及病理证实的胆囊癌28例.结果 主诉为右上腹疼痛24例,黄疽3例.术前确诊率96.43%.合并胆囊结石12例,占42.86%.Ⅱ期1例已生存4年尚无复发.1年生存率为38.46%.结论 原发性胆囊癌临床症状无特异性,影像学检查很重要,加强对胆囊癌诊断的意识及对易感人群进行超声筛查并结合CA199、CEA等肿瘤标志物分析对提高早期诊断率是必要的.     

60例胆囊癌的临床分析及预后

目的回顾性分析胆囊癌病人的临床病理资料并进行随访，探讨其临床病理特征及影响病人术后生存的因素。方法收集解放军总医院1999年7月至2005年7月间经手术切除并具有完整资料的原发性胆囊癌病例。回顾性分析胆囊癌病人的临床、病理资料，进行单因素及多因素预后分析。结果最终成功获得完整临床病理资料及随访资料的胆囊癌病人共60例，单因素分析显示病人Nevin分期、肿瘤分化程度、血管侵犯、肿瘤有无坏死及手术方式均为影响预后的因素。Cox多因素分析表明肿瘤的病理分期以及手术方式是影响病人术后生存时间的独立因素。结论影响胆囊癌病人术后生存的独立因素仅为肿瘤的病理分期以及手术方式。     

49例胆囊癌的外科治疗

目的 研究提高胆囊癌外科治疗疗效的途径。方法 选取1993～2001年间经手术治疗的胆囊癌患者49例,其中病变早期(Ⅰ、Ⅱ、Ⅲ期)组23例,行单纯胆囊切除术10例,根治性手术13例;晚期(Ⅳ、Ⅴ期)组26例,行姑息性手术6例,单纯胆囊切除2例,根治性切除18例。结果 病变早期组与晚期组的预后差异有显著性(P<0.05),早期组好于晚期组;在早期组的Ⅱ、Ⅲ期和晚期组患者,行单纯胆囊切除组与行根治性手术组的预后差异均有显著性(P<0.01),行根治性手术组预后好。结论 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。     

Adenoendocrine cell carcinoma of the gallbladder clinically mimicking squamous cell carcinoma

We present the case of a 62-year-old Japanese man whose histological diagnosis was adenoendocrine cell carcinoma of the gallbladder at autopsy, but whose antemortem diagnosis was squamous cell carcinoma. The patient was admitted to hospital with complaints of occasional vomiting and abdominal pain. Abdominal computed tomography revealed a large tumor on the gallbladder involving the adjacent liver, colon, and duodenum, with multiple metastases in the greater omentum and paraportal lymph nodes. The serum level of squamous cell carcinoma antigen (SCCA) was high, whereas that of carbohydrate antigen (CA) 19-9, as well as that of carcinoembryonic antigen (CEA) was within the normal range. Due to these clinical features, we first suspected advanced squamous cell carcinoma of the gallbladder. After two cycles of gemcitabine monotherapy, the tumor had become enlarged and the regimen was changed to a combination of docetaxel and cisplatin. Though tumor regression was achieved and his serum SCCA level normalized after 3 months, the patient rejected additional chemotherapy and died 8 months after the diagnosis. The histopathological findings made by autopsy demonstrated the tumor to be an adenoendocrine cell carcinoma without squamous carcinoma cells. The case is interesting in that the clinical features were similar to those of squamous cell carcinoma of the gallbladder.     

胆囊癌组织的比较蛋白质组学分析

目的 通过分离、鉴定胆囊癌和胆囊良性组织的差异表达蛋白质,探讨可能用于早期诊断或治疗胆囊癌的肿瘤标志物.方法 对6例人胆囊癌组织和胆囊良性组织进行比较蛋白质组学研究,采用双向凝胶电泳分离蛋白,经图像分析识别差异表达的蛋白.应用基质辅助激光解析电离飞行时间质谱(MALD-TOF-MS)鉴定差异蛋白质.采用免疫组化技术对差异蛋白磷脂酰乙醇胺结合蛋白1(PEBP1)进行验证.结果 获得了分辨率和重复性均较好的凝胶蛋白图谱.共筛选出46个在胆囊癌组织中明显差异表达的蛋白点,其中17个蛋白质鉴定成功.在这17个蛋白质中,胆囊癌组织中高表达9个,低表达8个.PEBP1在胆囊癌组织中的阳性表达率为74.0%.结论 成功鉴定了17个胆囊癌相关蛋白,为进一步筛选胆囊癌的诊断、治疗和预后评估的分子标志物奠定了基础.     

Role of tumor angiogenesis in gallbladder carcinoma: with special reference to thymidine phosphorylase

Background  Angiogenesis plays an important role in tumor growth and metastasis. Thymidine phosphorylase (TP), as well as vascular endothelial growth factor (VEGF), is known to be an angiogenic factor. The aim of this study was to clarify whether TP regulates angiogenesis and to determine the clinicopathological role of TP expression in gallbladder cancer. Methods  Thirty-seven patients with gallbladder cancer who underwent curative surgical resection were included in this study, and we evaluated results in 21 of these patients in whom TP gene expression could be measured. Intratumoral TP gene expression was evaluated using the Danenberg tumor profile method. TP gene expression was classified into two groups according to median values: high and low. Tissue TP expression was classified into two groups (positive and negative) by a pathologist. Clinicopathological variables were compared between groups with high and low TP gene expression (TP high and TP low groups). Results  No correlation was observed between TP gene expression (high and low groups) and any clinicopathological variables except survival rate. However, the survival rate was significantly lower in the TP high group (P < 0.05). TP gene expression was associated with tissue TP expression evaluated by immunohistochemical staining (P < 0.05). In addition, tumor microvessel density was significantly higher in the TP high group (P < 0.05). Conclusion  Expression of the TP gene in gallbladder carcinoma is associated with angiogenesis and may be a new independent prognostic parameter.     

原发性胆囊癌110例临床分析

目的分析了解原发性胆囊癌的临床特点。方法总结分析110例原发性胆囊癌患者的临床表现、影像学特点、诊断和治疗情况。结果胆囊癌患者早期诊断率为8.2%(9/110);女63例,男47例;年龄31～80岁,平均年龄57.3岁。临床表现无特异性,诊断主要依靠影像学检查。110例患者均首先行B超检查,其中57例再行CT检查,23例行MRI检查。110例患者中,57例行根治性切除术,41例行姑息性切除术。88例患者获随访,术后生存期15 d至5年11个月,中位生存期为6.5个月。结论原发性胆囊癌患者早期诊断率低,预后差,病史和影像学检查是诊断胆囊癌的重要依据。     

胆囊癌p16蛋白的表达意义

目的观察p16蛋白在胆囊癌中表达,了解其与胆囊癌发生、发展关系。方法采用免疫组织化学S—P方法检测41例胆囊癌,7例胆囊腺瘤、14例胆囊炎石蜡标本p16蛋白的表达水平。结果胆囊癌p16蛋白的阳性表达率为48．8％（20／41）,明显低于胆囊炎（92．1％）及胆囊腺瘤（10％）;且低分化癌组与高、中分化癌组,S4～S5期与S1～S2期、S3期比较均有显著性差异（P＜0．05）。结论p16蛋白表达与胆囊癌的分化程度、浸润深度及预后密切相关。     

Xanthogranulomatous cholecystitis misdiagnosed as gallbladder carcinoma： retrospective analysis of 10 cases

Objective： To investigate the reasons for misdiagnosing xanthogranulomatous cholecystitis （XGC） as gallbladder carcinoma, and to provide differential points between these two diseases. Methods： Thirty-three patients with the final diagnosis of XGC in our hospital over a period of 10 years （1996-2005） were reviewed, among which 10 （6 males and 4 females） were misdiagnosed as having gallbladder carcinoma either preoperatively or intraoperatively. Results： 10 misdiagnosed cases were examined preoperatively by B-ultrasound （BUS） and computed tomography （CT）. BUS and CT revealed 5 cases of gallbladder carcinoma and 1 of chronic cholecystitis; 2 cases were diagnosed as gallbladder carcinoma on BUS but chronic cholecystitis on CT; other 2 cases were diagnosed as chronic cholecystitis on BUS but as gallbladder carcinoma on CT. Intraoperatively, thickening of the gallbladder wall was found in all of the patients; xanthogranulomatous tissue was found invading into other tissues including gallbladder bed and omentum majus. Intraoperative frozen section investigation was performed on 1 patient revealing that no tumor cell was found. Open cholecystectomy ＋ partial hepatic wedge resection were performed on 3 patients; cholecystectomy ＋ partial hepatic wedge resection ＋ regional lymphadenectomy in the liver duodenum ligament on 6 patients; cholecystectomy ＋ cholecystoenterostomy ＋ colocolic anastomosis after partial resection of transverse colon on 1 patient. Postoperative pathological findings revealed XGC in all these patients. Conclusion： XGC is an uncommon variant of chronic cholecystitis of which clinical and imaging presentations closely resemble gallbladder carcinoma. Thus differentiation is essential by means of intraoperative frozen section investigation to ensure optimal surgical treatment since XGC has its pathological distinctions, which are not that of a precancerous change.     

p16基因产物表达与胆囊癌生物学行为和预后的关系

目的与方法:为了解p16基因与胆囊癌发生、生物学行为和预后的关系,采用免疫组化ABC法对36例胆囊癌和20例胆囊腺瘤中的p16蛋白进行了检测.结果:胆囊癌中p16蛋白的阳性率低于胆囊腺瘤(P<0.05);不同组织类型和分化程度不同的胆囊癌之间p16蛋白的阳性率无明显差别(P>0.05);p16蛋白的表达与胆囊癌有无浸润和淋巴结转移及病人的生存期密切相关(P<0.05).结论:p16基因失活与胆囊癌的发生有关,p16蛋白表达缺失与胆囊癌进展和预后不良有关.