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目的 了解我国胆囊癌人群、地理和时间分布和特征。方法 回顾性分析３９２例全国胆囊癌临床流行病学调查资料;结果 我国胆囊癌（１）占同期胆道疾病构成比的０．４－３．８％,平均为１．５３％;胆囊癌占同期普通外科疾病的构成比为０．１￣１．１％,平均为０．２８％。（２）以老年女性为主。（３）在我国西北和东北地区发病比长江以南地区高。农村比城市发病率高。（４）合并胆囊结石者为４９．７％,患者胆囊结石发生胆囊癌     

430例胆囊癌临床流行病学调查分析

对２８家医院１９８６－０１９９６年间的４３０便胆囊癌行回顾性分析。结果：（１）胆癌老年女性多见。（２）胆囊癌占同期胆道疾病的１．６％，并存胆结石发生率５０％。（３）临床表现为上腹痛、恶心、黄疸等。（４）以胆囊腺癌为主，填满型胆囊癌最多（５８％）。（５）胆管转移和肝脏转移是主要转移方式。（６）Ｂ超和ＣＴ一诊断率分别为７７％和６６％，近５年其对早、中期胆囊癌的术前诊断率显著提高。（７）Ⅰ、Ⅱ期胆囊癌手     

胆囊癌患者血清IL—2,sIL—2R及CEA水平的研究

胆囊癌是胆道系统常见的恶性肿瘤，其发病率近年来有增高趋势，研究发现有４０％～１００％的胆囊癌合并胆囊结石。为了研究ＩＬ２、ｓＩＬ２Ｒ和ＣＥＡ在胆囊癌患者血清中的水平及相互关系，以及从免疫学方面来探讨胆囊结石与胆囊癌之间的关系，作者采用ＲＩＡ及ＥＬＩＳＡ法，检测了４０例胆石症患者、２７例胆囊癌患者和２１例伴胆石症的胆囊癌患者的血清ＩＬ２、ｓＩＬ２Ｒ和ＣＥＡ值。对象和方法１．检测对象：胆石症患者４０例，其中男２０例，女２０例，年龄５０～６５岁，平均（５８－１４±５－１）岁；单纯性胆囊癌患者２…     

原发性胆囊癌P53过度表达及临床意义

我院１９８８年元月～１９９６年６月，共手术治疗原发性胆囊癌３０例，对３０例切除标本行免疫组化染色，测定Ｐ５３基因蛋白，另取同期３０例胆囊炎胆囊结石病人做对照，结果原发性胆囊癌Ｐ５３表达率为４６．７％，对照组阴性，Ｐ＜０．０５。肿瘤恶性程度越高，Ｐ５３表达率越高。高分化腺癌与低分化腺癌分别为２８．６％、７４．０％。Ｐ５３阳性者预后较差，五年存活率为１５．４％，阴性者为４２．９％。     

胆囊结石与早期胆囊癌

胆囊癌虽占消化道恶性肿瘤的第五位［１］,但在胆道恶性肿瘤中却居首位［２］。虽然我国的胆囊癌只占胆道手术的０－９６％～４－９％［２］,但其早期诊断困难,有人指出术前能诊断该病者仅有３４－７８％［３］。我院近２２年间经手术与病理确诊的胆囊癌３９例,占同期各种胆道手术１２１７例之３－２％。术前诊断为胆囊占位病变或不除外胆囊癌者２１例（占５３－８５％）其中晚期癌１８例。早期胆囊癌诊断难,晚期的疗效差。为实现早诊、早治就必须深入研究诱发胆囊癌的各种危险因素。胆囊癌的确实发病原因迄今尚未肯定。但多年来众多学…     

原发性胆囊癌44年诊治的临床回顾

目的：总结原发性胆囊癌的诊治经验,以利全面地认识本病、完善地制订诊治方案,提高疗效。方法：回顾性 分析我院４４年来收治的６９９例原发性胆囊癌临床资料。结果：６９９例胆囊癌患者中,男１９３例,女５０６例,男女之比为１： ２．６;年龄２５—８５岁,平均５６．４岁,５５岁以上者占６５．５％。有３８１例（５４．５％）合并胆囊良性疾病,胆囊结石占３６７例 （５２．５％）。病理类型：腺癌９４．９％,腺瘤癌变０．６％,息肉癌变１．２％,鳞癌１．５％,腺鳞癌１．８％; ＮｅｖｉｎⅠ期１．５％, Ⅱ期 １７．４％,Ⅲ期１６．２％,Ⅳ期２４．１％,Ⅴ期４０．８％。Ｂ超检查确诊率为７４．０％（３６５／４９３）,ＣＴ检查确诊率为８７．６％（８５／９７）。 ２３４例行非手术治疗,４６５例行手术治疗。单纯胆囊切除术７９例,根治性胆囊切除术４７例,扩大切除术１９例。早期病例 单纯胆囊切除术后５年生存率优于晚期病例扩大切除术（Ｐ＜０．０５）,对于Ⅱ期病例,根治性胆囊切除术后５年生存率 高于单纯胆囊切除术（Ｐ＜０．０５）。结论：改善胆囊癌预后的关键是：①加强高危人群监测,研究新的诊断技术和指 标,真正提高早期诊断水平;②对早期病例应尽量做根治性胆囊切?     

原发性胆囊癌的高危因素

原发性胆囊癌由于缺少特有的临床表现,一经发现多属中晚期,疗效及预后极差。近年对其发病高危因素的研究越来越多的受到关注,且有一定进展,综述如下。１．胆石症与胆囊癌胆囊结石可以诱发癌变已被大多数外科学者所承认,全国第七届胆道外科会议资料表明６０％胆囊癌合并有胆结石〔１〕,我院资料表明４２％胆囊癌病人合并有胆囊结石〔２〕,Ｌｏｗｅｎｆｅｌｓ的研究将有无胆囊结石的人群中胆囊癌的发病率加以对比,发现有结石的患病率是无结石的２９－９倍〔３〕。胆囊癌的发生不仅与胆囊结石有关,更与结石的大小有关,Ｄｉｅｈｌ〔４…     

胆囊结石行胆囊切除术后诊断胆囊癌46例报告

胆囊结石行胆囊切除术后诊断胆囊癌４６例报告宋录金邓亚莉王克成宋卫林我院自１９８８年１月～１９９６年１月临床诊断胆囊结石施行胆囊切除术８４２０例，术后病理诊断为胆囊癌４６例（０５５％），报道如下。１临床资料本组男１２例，女３４例。年龄４７～７６岁。术...     

原发性胆囊癌30例诊治体会

报道３０例经手术证实的原发性胆囊癌，其误诊率高达３０．０％（９／３０），合并胆囊结石者占８３．３％（２５／３０），肿瘤向肝脏转移者占５３．３％（１６／３０），且转移早；绝大多数胆囊癌是腺癌。结果表明胆囊癌与胆囊结石关系密切，早期治疗效果好，一旦出现肝转移则预后不良。并就有关术式进行了讨论。     

胆囊癌和胆囊结石相关危险性的分析

目的 明确胆囊癌和胆囊结石之间的相关关系。方法 回顾性调查了全国28个省市的3922例胆囊癌，结合病例对照方法研究胆囊结石的病程，胆囊结石大小和胆囊癌的关系。结果 (1)胆囊癌合并胆囊结石的发生率为46．7％，胆囊癌伴发胆囊结石的相对危险度为13．7。(2)合并胆囊结石的病程平均为10～15年。(3)胆囊结石直径大于3cm比结石直径在1cm内的风险高8．8倍。结论 直径大于3cm，病程达10～15年的胆囊结石是胆囊癌发生的高危险因素，建议对这类病人进行手术治疗。     

胆囊癌癌前病变的新认识与处理原则

原发性胆囊癌作为最常见的胆道恶性肿瘤,恶性程度较高,术前明确诊断率低,临床上确诊时大多属中晚期,总体预后较差。胆囊癌病因迄今未明确,胆囊黏膜的不典型增生和胆囊腺瘤是目前公认的胆囊癌癌前病变。而部分胆囊炎、胆囊结石、胆囊息肉样病变以及先天性胰胆管合流异常等胆囊良性疾病可能通过一定的病理生理过程而逐渐演变成胆囊癌癌前病变,进而发展成为胆囊癌。因此,重视胆囊癌癌前病变,把握合理的手术时机,以提高胆囊癌的存活率。     

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??Study on the relationship between gallbladder cholesterol polyps and the pathogenesis of gallstones JIAO Da-hai*, HAN Tian-quan, JIANG Zhao-yan, et al. *Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Minimally Invasive Surgery Center, Shanghai 200025, China Corresponding author: WANG Ming-liang, Email: mingliangwang@hotmail.com Abstract Objective To study on the relationship between gallbladder cholesterol polyps and the pathogenesis of gallstone. Methods gallbladder stone, bile and part of gallbladder full-thickness tissue were collected from 62 patients who underwent laparoscopic cholecystectomy from April 2008 to september 2008 in our center, including 31 patients with gallbladder cholesterol polyps, 18 patients with cholesterol gallstones and 13 patients in control??6 patients with gallbladder adenoma and 7 patients with non-cholesterol gallstone ). sonography was applied to measure the gallbladder three diameter before and 1 hour after breakfast to evaluate the contracted function of gallbladder. The contents of cholesterol in gallstone and cholesterol, bile acid and phospholipid in bile were measured, and the full-thickness tissue of the gallbladder wall was done the pathological examination. Results Emptying Rate of Gallbladder in the patients with cholesterol polyps was(47.3±18.6) %, it was significantly decreased comparing with those that in the healthy people(71.7±8.1)%, P??0.01, but there ware no differences between the patients in group of cholesterol polyps and in group of gallstones??47.6±23.7??%. Cholesterol saturation index was higher in the patients with cholesterol polyps comparing with those that in control group(1.0±0.2 vs 0.6±0.3, P??0.01), but there ware no differences between the patients in group of cholesterol polyps and in group of gallstones (1.0±0.2 vs1.0±0.2, P??0.05). Gallstones and cholesterol polyps coexistence in 13 patients among 31 patients who with the gallbladder cholesterol polyps, and the incidence of gallstone is 41.9%. Conclusion the existence of gallbladder cholesterol polyps may lead to the formation of gallbladder stone.     

腹腔镜胆囊切除术结石漏入腹腔的预防

目的:探讨腹腔镜胆囊切除术（LC）中结石漏入腹腔的原因、预防措施及处理方法。方法:回顾分析1510例LC术中73例结石漏入腹腔发生的原因及处理方法。结果:结石自胆囊管破口漏出6例,牵拉和剥离致胆囊破裂结石漏出41例,自腹壁戳孔取出胆囊时拉破19例,血管钳扩大戳孔刺破胆囊7例。漏入腹腔的结石均被取出,2例中转为开腹取石。此组结石漏入腹腔的发生率为4.8％（73/1510）。结论:LC术中剥离和取出胆囊过程是结石漏入腹腔的主要发生时期,防止胆囊分破和取出时拉破是预防结石漏入腹腔的关键。     

血管内皮生长因子与E-钙粘蛋白在胆囊癌组织中的表达研究

目的：探讨血管内皮生长因子（Vascular endothelial growth factor,VEGF)与F－钙粘蛋白（E－Cad)在胆囊癌组织中的表达及与胆囊癌发生发展的关系。方法：应用免疫组织化学法检测14例胆囊腺癌和41例胆囊癌组织中VEGF、E－Cad的表达。结果：VEGF阳性表达率胆囊腺瘤中为42．86％，胆囊癌组织中为80．49％，二者差异有显著意义（P＜0．05），E－Cad在胆囊腺瘤中仅1例表达减弱，而在胆囊癌组织中表达减弱或不表达占68．29％（28／41），差异有非常显著意义（P＜0．01）。胆囊癌直径≥2cm及侵及浆膜组VEGF表达升高，而E－Cad表达率明显降低，E－Cad表达率在远处转移组也明显降低。两者表达与肿瘤Nevin分期、组织学分级及有无淋巴结转移无关。结论：VEGF与E－Cad在胆囊癌发生和浸润转移过程中发挥重要作用，两者表达率的高低可作为预示胆囊癌进展及判断预后的指标。     

Contractile function of the gallbladder after gastrectomy

Gallbladder contractile function was observed by B-mode ultrasonography on patients with radical gastrectomy for gastric carcinoma (20 cases), with subtotal gastrectomy for peptic ulcer (36 cases), and with highly selective vagotomy (7 cases). Thirty-one preoperative patients with peptic ulcer were used as control. It was found that within one month after radical or subtotal gastrectomy the average area and the volume of the gallbladder became much larger than that found in control group. The empty rate of the gallbladder was found decreased and the remainder bile increased. Early stage gallstones were found in two cases 11 and 13 months after gastrectomy. The inner diameter of the common bile duct was increased after radical gastrectomy. No definite relationship was found between gallbladder contractile disfunction and the mode of gastroenterostomy. It was also found that highly selective vagotomy had only slight influence on the biliary tract. These results suggest that gastrectomy has significant influence on the function of biliary tract and plays an important role in the formation of gallstones.     

胆囊结石时胆囊粘膜的病理损害及其与胆囊癌的关系

目的 研究胆囊结石时胆囊粘膜的病理损害过程中细胞ＤＮＡ及核仁形成体区嗜银蛋白（Ａｇｎｏｒ）含量的改变,探讨各型病理改变在胆囊癌发病中的位置。方法 应用免疫组织化学方法对１５６例胆囊结石及９例合并结石的胆囊癌标本进行对照研究。结果 胆结石引起胆囊粘膜典型增生、非典型增生及胆囊癌的发生率分别为７５．１５％、１９．３９％、５．４５％。引起粘膜的肠上皮化生发生率为３８．７８％。从单纯增生、非典型增生到胆囊癌细胞Ａｇｎｏｒ蛋白及ＤＮＡ含量逐级增高。结论 胆囊结石可引起不同程度的粘损伤,粘膜的非典型增生为胆囊癌的癌前病变。     

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??New understanding and treatment principle of precancerosis of gallbladder carcinoma ZHAO Gang, WU Zhi-yong. Department of General Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
Corresponding author: WU Zhi-yong, E-mail:zhiyongwu@gmail.com
Abstract Gallbladder carcinoma is the most common carcinoma of biliary tract and has high degree of malignancy. Most of the clinical diagnosis is in the late stage, because gallbladder carcinoma has low rate of preoperative diagnosis. The overall prognosis is poor. Now the cause is not clear. Dysplasia of gallbladder mucosa and gallbladder adenoma are recognized as precancerosis of gallbladder carcinoma. And some benign gallbladder diseases such as cholecystitis, gallstones, polypoid lesions of the gallbladder and anomalous junction of the pancreaticobiliary duct gradually may evolve into precancerosis of gallbladder carcinoma by the process of pathophysiology??then develop into gallbladder carcinoma. Therefore, It should pay more attention to precancerosis of gallbladder carcinoma and choose a reasonable time of surgery to improve the survival rate.     

Gallbladder ascariasis: presentation and management

BACKGROUND: As many as 1.5 billion people around the world harbour Ascaris lumbricoides in the digestive tract. Gallbladder ascariasis, although less common than bile duct ascariasis, is quite often seen in endemic areas. METHODS: Some 1300 patients with hepatobiliary ascariasis, admitted between October 1992 and June 1998, were analysed prospectively. The clinical features and outcome of 56 cases of gallbladder ascariasis are presented. RESULTS: Forty-seven patients were diagnosed by ultrasonography and nine were diagnosed at laparotomy. Only ten patients diagnosed by ultrasonography expelled the worms spontaneously, with resolution of symptoms and signs. The remaining 37 patients underwent cholecystectomy. CONCLUSION: Gallbladder ascariasis is a significant entity in endemic areas which usually requires cholecystectomy.     

Polypoid lesions of the gallbladder

26 cases of polypoid lesions of the gallbladder are reported. 19 were benign lesions, among them, there were 12 (63%) cholesterol polyp, 4 adenoma, 1 inflammatory polyp, and 2 others. 95% of benign lesions were less than 1 cm in diameter, 63% of which were less than 0.5 cm in diameter, 15 cases were multiple lesions; all cases were not associated with gallstones. 7 cases were carcinoma of the gallbladder, of which, 5 were more than 1 cm in diameter, 2 were less than 1 cm which were carcinoma in situs; 3 were associated with gallstones. The accuracy of preoperative diagnosis of polypoid lesions of the gallbladder made by B-mode ultrasonography, cholecystography, CT, endoscopic ultrasonography were 84%, 53%, 80% and 75% respectively. It is concluded that preoperative diagnosis of polypoid lesions on the gallbladder mainly depends on the B-mode ultrasonography; the lesions less than 0.5 cm in diameter should not be treated by operation for the time being; the lesions between 0.5-1 cm should be followed up by B-mode ultrasonography; the operation may be considered if stones present; the lesions more than 1 cm should be resected since malignancy could not be excluded.