原发性胆囊癌早期诊断与误诊分析

原发性胆囊癌并非罕见。由于缺乏典型症状、体征,常易延误诊断,一旦确诊多属晚期,给预后带来严重恶果。据Stratford氏报道,仅50%可作手术切除,术后五年生存率也仅2%。本文仅就我院近几年收治的7例胆囊癌,结合早期诊断与误诊分析,作一讨论。一般资料本组女5、男2。其中右上腹痛向右肩背放散3例,上腹闷胀1例,黄疸2例,无     

胆囊癌的诊断治疗进展——胆囊癌的病理、转移及预后

胆囊癌是恶性程度最高、最常见的胆道系统肿瘤，发生于胆囊底部60％、体部30％、颈管部10％。发病隐匿，预后极差，因此应高度重视并了解胆囊癌的病理分型、分期、转移及预后情况。     

进展期胆囊癌的超声诊断及临床价值探讨

目的探讨进展期胆囊癌的超声特征及临床应用价值。方法回顾性分析了43例经手术和病理证实的进展期胆囊癌的超声特征，并对漏误诊病例进行分析。结果胆囊癌的超声图像分为四型：壁增厚型、蕈伞型、混合型、实块型，同时可观察肝转移、肝浸润、区域淋巴结肿大、胆结石、胆管扩张等征象。结论超声诊断胆囊癌及判断其转移情况符合率高，对临床外科提供了有益的帮助。     

新肿瘤标志物MGAg诊断胆囊癌

应用本学科研制的胃癌单克隆抗体,建立一步法免疫放射分析,检测血清中肿瘤相关抗原MGAg的含量,观察其在胆囊癌诊断中的价值。 1 材料和方法 1.1 单克隆抗体MG7的纯化和碘标记 含抗体的小鼠腹水经50％饱和硫酸铵沉淀,沉淀物经10mmol pH 8.0 Tris-HCl充分透析,过DE_(52)阴离子纤维素层析柱,取首峰备用。     

肺癌诊断的某些新的进展

本文综述了影像学，组织活检，镜检，肿瘤标记物及基因诊断等在肺癌诊断中的某些进展，这些新技术的应用为肺癌的早期诊断，分期，鉴别诊断等方面提供新的帮助。     

30例胆囊癌的CT检查结果分析

原发性胆囊癌临床少见 ,早期诊断困难。为探讨 CT对胆囊癌的诊断价值 ,现将我们收治的 3 0例胆囊癌患者的 CT表现和特征分析如下。资料与方法 :本组男 3例 ,女 2 7例 ;年龄 3 5～ 72岁 ,平均 5 1岁。临床表现为恶心、呕吐 2 1例 ,右上腹持续疼痛19例 ,黄疸 2例 ,发热 12例。均接受手术治疗 ,术后病理诊断为腺癌 2 5例 ,鳞癌 2例 ,未分化癌 2例。术前均行 CT检查 ,层厚、层距为 10 m m ,扫描范围从膈顶到肝脏下缘 ,必要时加扫 3～ 5 m m薄层。增强扫描采用 60 %复方泛影葡胺 90～ 10 0 ml,注射速度 2～ 3 ml/ s,注射造影剂 60～ 70秒后扫…     

胆囊癌的诊断与治疗进展

胆囊癌是胆道系统常见的恶性肿瘤,早期症状特异性差,恶性程度极高,进展迅速,难以早期诊断。胆囊结石、胆囊息肉等被认为是最常见的危险因素。超声检查是其首选检查,CT、MRI、PET等也各具优势。胆囊癌缺乏根治性治疗手段,外科手术仍是胆囊癌首选的治疗方式,但其进展迅速,很多患者确诊时已难以行手术治疗,放化疗、靶向治疗、免疫治疗等多种治疗方式联合,在一定程度上改善了患者预后,但其远期治疗效果仍不理想,因此,预防为主、治疗为辅,早发现、早治疗显得尤为重要。     

超声造影诊断胆囊癌的表现特征分析

目的 分析超声造影（CEUS）检查诊断胆囊癌的价值。方法 采用CEUS检查18例经术后组织病理学检查诊断的胆囊癌和35例胆囊良性病变患者,分析其CEUS表现特征。结果 18例胆囊癌主要表现为局限性不规则病变11例,弥漫型不规则病变7例;胆囊壁厚度为（27.2±13.1） mm,显著厚于胆囊良性病变【（15.5±1.6）mm,P<0.01】;在增强初期,胆囊癌表现为高增强或等增强,在注射造影剂35s后转为低增强,发生病变处的胆囊壁完整性被破坏;胆囊壁呈不均匀性强化者为83.3%,显著高于良性病变患者的17.1%（P<0.01）;本组病例经CEUS检查,术前诊断为胆囊癌17例（94.4%）,准确判定良性病变33例（94.3%）。结论 CEUS检查能明确诊断胆囊癌,并与良性病变区别良好,有很好的临床应用价值。     

超声诊断原发性胆囊癌

我们搜集总结了近期21例经临床及手术病理证实的胆囊癌有关的超声检查资料，探讨超声检查在临床其诊断中的价值。     

内镜超声检查对胆囊癌的诊断价值

目的探讨内镜超声检查(EUS)对胆囊癌的诊断价值。方法对18例胆囊癌患者行EUS 检查并与体表B超(B超),X线电子计算机断层扫描(CT)/磁共振成像(MRI)结果进行比较。结果18例中EUS诊断17例,CT/MRI诊断15例,B超诊断5例。EUS诊断胆囊癌的敏感性与准确性高于B超,与CT/MRI相当。13例行手术治疗,与手术病理组织检查比较,EUS诊断正确率为92％,CT/MRI为76.9％,差异无显著性(P＞0.05)。B超为41.6％,差异有非常显著性(P＜0.01)。EUS对小病灶的显示明显优于B超,并优于CT/MRI。结论EUS对胆囊癌有较高的诊断价值。     

Combined detection tumor markers for diagnosis and prognosis of gallbladder cancer

AIM:To clarify the value of combined use of markers for the diagnosis of gallbladder cancer and prediction of its prognosis.METHODS:Serum cancer antigens(CA)199,CA242,carcinoembryonic antigen(CEA),and CA125 levels were measured in 78 patients with gallbladder cancer(GBC),78 patients with benign gallbladder diseases,and 78 healthy controls using electrochemiluminescence.CA199,CA242,CEA,and CA125 levels and positive rates were analyzed and evaluated pre-and postoperatively.Receiver operator characteristic curves were used to determine diagnostic sensitivity and specificity of GBC.Survival time analysis,including survival curves,and multivariate survival analysis of a Cox proportional hazards model was performed to evaluate independent prognostic factors.RESULTS:Serum CA242,CA125,and CA199 levels in the GBC group were significantly higher when compared with those in the benign gallbladder disease and healthy control groups(P<0.01).With a single tumor marker for GBC diagnosis,the sensitivity of CA199 was the highest(71.7%),with the highest specificity being in CA242(98.7%).Diagnostic accuracy was highest with a combination of CA199,CA242,and CA125(69.2%).CA242 could be regarded as a tumor marker of GBC infiltration in the early stage.The sensitivity of CA199 and CA242 increased with progression of GBC and advanced lymph node metastasis(P<0.05).The78 GBC patients were followed up for 6-12 mo(mean:8 mo),during which time serum CA199,CA125,and CA242 levels in the recurrence group were significantly higher than in patients without recurrence(P<0.01).The post-operative serum CA199,CA125,and CA242levels in the non-recurrence group were significantly lower than those in the GBC group(P<0.01).Multivariate survival analysis using a Cox proportional hazards model showed that cancer of the gallbladder neck and CA199 expression level were independent prognostic factors.CONCLUSION:CA242 is a marker of GBC infiltration in the early stage.CA199 and cancer of the gallbladder neck are therapeutic and prognostic markers.     

A case of gallbladder carcinoma associated with pancreatobiliary reflux in the absence of a pancreaticobiliary maljunction： A hint for early diagnosis of gallbladder carcinoma

A 62-year-old man with progressive thickening of the gallbladder wall visited our outpatient clinic. The biliary amylase level in the common bile duct was 19900 IU/L and that of the gallbladder was 127000 IU/L, although endoscopic retrograde cholangiopancreatography revealed no pancreaticobiliary maljunction. Histology demonstrated a moderately differentiated adenocarcinoma of the gallbladder. Pancreatobiliary reflux and associated gallbladder carcinoma were confirmed in the present case, in the absence of a pancreaticobiliary maljunction. Earlier detection of the pancreatobiliary reflux and progressive thickening of the gallbladder wall might have led to an earlier resection of the gallbladder and improved this patient's poor prognosis.     

Two cases of neuroendocrine carcinoma of the gallbladder

Neuroendocrine carcinoma (NEC) of the gallbladder is a rare subtype of gallbladder tumor. Here, we report two cases of NEC in two patients initially suspected to have gallbladder carcinoma. No specific symptoms or abnormal blood test results were observed preoperatively. Abdominal computed tomography scans indicated intraluminal masses in the gallbladder and lymph node enlargement in the hepatic hilum. Radical cholecystectomy and regional lymphadenectomy were performed. The first patient also presented with liver invasion and therefore underwent resection of liver segment IV. A diagnosis of NEC was made upon postoperative pathological examination and immunohistochemical staining according to the WHO Classification of Tumors of the Digestive System (2010). One tumor was identified as poorly differentiated NEC and the other as poorly differentiated mixed adenoneuroendocrine carcinoma. Immunohistochemical staining data from both tumors showed positivity for chromogranin A and synaptophysin. The first patient received 4 cycles of chemotherapy consisting of cisplatin and etoposide. No metastases or recurrence were observed 12 mo following surgery. The second patient refused chemotherapy and presented with tumor recurrence 4 mo after surgery. In conclusion, NEC of the gallbladder is an aggressive tumor and the identification of a standardized optimal treatment still requires further research. Our experience together with published studies suggests that radical surgery and adjuvant chemotherapy may improve the prognosis.     

AFP阴性肝癌的肿瘤标志物诊断的研究进展

甲胎蛋白(alpha-fetoprotein,AFP)是肝细胞癌(hepatocellular carcinoma,HCC)的主要标志物,测定血清AFP水平是目前诊断HCC的主要手段.约1/3的HCC患者血清AFP水平正常,即所谓的AFP阴性肝癌,这部分患者的诊断是目前肝癌诊断中需解决的关键问题.多年来,人们一直在寻找能弥补AFP不足的肝癌标志物,以提高HCC的诊断水平.本文综述了有关AFP阴性肝癌的肿瘤标志物诊断研究进展,主要内容包括传统肝癌标志物对AFP阴性肝癌的诊断价值,新肝癌标志物对AFP阴性肝癌的诊断价值,以及对AFP阴性HCC具有潜在诊断价值的生物标志物.     

胆囊癌组织微血管密度变化及其与预后的关系

应用抗人Ⅷ因子相关抗原(F8-RA)多克隆抗体、免疫组织化学(SABC)法，检测40例胆囊癌组织中（MVD)的表达，并分析其与胆囊癌临床病理及预后的关系。结果发现，胆囊癌组织MVD值与肿瘤浸润深度、临床病理分期、淋巴结转移密切相关，与病理类型及分化程度无关。MVD值较高者，中位生存期及3年生存率显著降低。提示胆囊癌组织MVD的增加，可促进病变的发展和转移；检测胆囊癌组织MVD对判断胆囊癌的预后有重要意义。     

肿瘤标志物CA199联合螺旋CT检查胆囊癌33例

目的:探讨肿瘤标志物CA199测定联合螺旋CT检查对胆囊癌的诊断价值.方法:回顾性分析胆囊癌33例,所有患者术前测定血清CA199含量,并行螺旋CT检查.结果:术前CT、CAl99、CT联合CA199诊断符合率依次为72.73%、81.82%和66.67%,差异无统计学意义(X~2=1.98,P>0.05).16层螺旋CT术前诊断胆囊癌24例,包括肿块型10例、壁厚型8例、腔内型胆囊癌6例.结论:CA199测定有利于胆囊癌的早期发现,螺旋CT检查及其分型可为术前制订治疗方案提供依据,两者联合对胆囊癌诊断的灵敏性无影响,但可以提高特异性.     

管壁增厚型胆囊癌患者MRI影像学特征分析

目的 探讨慢性胆囊炎与壁增厚型胆囊癌患者磁共振成像(MRI)影像学特征异同,以帮助对壁增厚型胆囊癌患者的鉴别诊断.方法 2019年1月～2020年12月我院收治的胆囊疾病患者60例,使用超导MRI成像仪进行影像学检查,比较慢性胆囊炎和胆囊癌的MRI影像学特征差异.对慢性胆囊炎患者,行胆囊切除术,对胆囊癌患者,行肿瘤切除...     

Rational therapeutic strategy for T2 gallbladder carcinoma based on tumor spread

AIM:To evaluate the adequacy of surgical treatment of T2 gallbladder carcinoma(GBCa)according to tumor spread in the subserosal layer. METHODS:A series of 84 patients with GBCa were treated at Saga University Hospital,Japan between April 1989 and October 2008.The tumor stage was graded according to the TNM staging for GBCa from the American Joint Committee on Cancer Manual 6th edition. Tumor staging revealed 30 patients with T2 tumors.T2 GBCa was divided into three groups histologically by the extent of tum...     

CT检查对诊断胆囊腺肌症的效能分析*

目的 总结胆囊腺肌症与胆囊癌患者多层螺旋CT(MSCT)表现特征。方法 2015年9月～2020年9月我院诊治的胆囊腺肌症患者113例和胆囊癌患者78例,均接受MSCT和超声检查,外科手术治疗后行组织病理学检查。结果 MSCT检查结果与术后组织病理学检查结果的一致性(Kappa=0.749)显著高于超声检查(Kappa=0.577);MSCT诊断胆囊腺肌症的准确度为88.0%,显著高于超声检查的79.6%(P<0.05);MSCT对局限型胆囊腺肌症的检出率为97.1%,显著高于超声检查的82.9%(P<0.05);在CT检查上,胆囊腺肌症表现为胆囊壁光滑、RAS窦和肝胆交界清楚显示率分别为36.3%、36.3%和69.0%,显著高于胆囊癌组的9.0%、6.4%和38.5%(P<0.05)。结论 MSCT检查诊断胆囊腺肌症有较高的正确率,其特征有助于与胆囊癌鉴别。