原发性胆囊癌的临床特点

目的探讨原发性胆囊癌的临床特点、早期症状及治疗方法。方法对2000年~2003年收治的19例原发性胆囊癌患者的临床资料进行回顾性分析。结果首发症状多为反复右上腹疼痛,68·4%的胆囊癌合并胆囊结石;B超对胆囊癌的诊断率为50%,CT和MRI的诊断率均为75%;治疗方法以早期手术切除治疗效果较好。结论胆囊癌的发生与胆囊结石关系密切,早期诊断与手术切除是提高原发性胆囊癌患者生存率的关键。     

胆囊癌之探讨

目的 探讨胆囊癌诊断及治疗。方法 回顾性总结1995～2001年胆囊癌35例外科治疗资料。结果 男性12例，女性23例，平均年龄65岁。并存胆囊结石20例，合并结石率57．1％。术前通过B超或CT证实为胆囊结石或怀疑胆囊有占位者5例。32例就诊时已属中晚期。手术切除7例。组织学类型95％为腺癌。结论 胆囊癌早期诊断率低。胆囊结石可以诱发胆囊癌。对于年龄大、病史长的胆囊结石等高危人群应定期随访，B超跟踪，尽早手术，以提高疗效。     

超声内镜引导细针穿刺抽吸/活检术诊断胆囊癌的研究进展

胆囊癌侵袭性强，进展速度快，早期诊断胆囊癌是提升预后的关键。本综述回顾了以胆囊为靶点的超声内镜引导细针穿刺抽吸/活检术（endoscopic ultrasound‑guided fine needle aspiration/biopsy，EUS‑FNA/B）诊断胆囊癌的研究，总结了EUS‑FNA/B对胆囊癌的诊断效能、可能影响诊断率的因素以及不良事件。     

超声内镜引导细针穿刺抽吸/活检术诊断胆囊癌的研究进展

胆囊癌侵袭性强, 进展速度快, 早期诊断胆囊癌是提升预后的关键。本综述回顾了以胆囊为靶点的超声内镜引导细针穿刺抽吸/活检术(endoscopic ultrasound-guided fine needle aspiration/biopsy, EUS-FNA/B)诊断胆囊癌的研究, 总结了EUS-FNA/B对胆囊癌的诊断效能、可能影响诊断率的因素以及不良事件。     

40岁以下原发性肺癌患者临床病理分析

回顾分析了86例40岁以下原发性肺癌患者的临床病理表现，并将其发病特点、组织学类型、TNM分期及治疗方法等与同期随机选择的110例40岁以上原发性肺癌患者比较。结果表明：青年女性肺癌比例明显增高，病理类型以腺癌为主，临床上早期诊断率低，手术机会较少。     

当前胆囊癌根治切除应注意的问题

原发性胆囊癌(primary carcinoma of the gallbladder,PCG)是胆道系统常见的恶性肿瘤,发病率占消化道恶性肿瘤的第5位。其起病隐匿,恶性程度高、侵袭能力强、预后很差。近年来国内对该病的报道不断增加,发病率有增高趋势,治疗效果一直是人们所关注的问题。尽管如此,手术仍然被作为治疗胆囊癌的唯一有效手段,目前认为提高早期诊断率以及采取合理的     

胰腺癌的实验诊断近展

近年来,胰腺癌呈现出“一高三低”的趋势,即发病率升高,早期诊断率低,根治手术率低,5年存活率低。要改善这种状况,关键是提高早期诊断率。由于人们想探索出筛选和早期诊断胰腺癌的有效手段,故近年来胰腺癌的实验室诊断研究发展较快。     

老年胆囊癌30例

目的探索老年人胆囊癌的发病特点，提高早期诊断率．方法报道1987／1991经手术和病理证实的老年人胆囊癌30例，其中男9例，女21例．结果30例中18例伴胆囊结石，病程4d～3a，病变可切除者5例．主要表现右上腹不适20例，呕吐11例等．浸润型腺癌22例（73％），ALT正常19例，ALT＞正常值21例，AKP正常10例，AKP＞正常值20例．做B超30例，阳性20例（67％），做CT4例，阳性2例，口服及静脉胆囊造影4例，均显示胆囊不显影．出现并发症21例，以胆囊穿孔4例、胆囊积水3例、肝转移10例多见．结论老年人胆囊癌以女性多见，大多伴慢性胆囊炎、胆结石，起病隐匿，临床表现缺乏特异性，早期诊断困难，加之各器官功能衰退，储备力差，并发症多．本组B超诊断符合率67％，具有价廉、简便、无创等优点．可作为老年人检查的首选项目，CT配合B超可提高早期诊断率．观察表明：60岁以上老年女性长期有胆囊炎、胆囊结石病史，近期症状加重，出现右上腹不适及包块、消瘦、ALT及AKP升高，胆囊影像学检查异常考，应高度怀疑胆囊癌的可能．     

胆囊癌外科治疗的疗效分析

原发性胆囊癌是胆道系统最常见的恶性肿瘤，恶性程度高，进展期胆囊癌预后很差，有的放弃了根治性的手术治疗。我们1981—05／2005—04手术治疗14例胆囊癌病人，发现早期胆囊癌手术效果好，有1例已存活18年；对进展期胆癌行根治性手术可延长生存时间，姑息性效果很差；现将本组病例治疗及转归情况总结报告如下。     

胆囊癌的螺旋CT诊断

胆囊癌起病隐匿，临床症状出现较晚，早期不易被发现，预后较差。我们收集12例经临床手术病理证实的胆囊癌的螺旋CT资料，以探讨该项检查对胆吓癌的诊断价值。     

Diagnosis and treatment of gallbladder perforation

INTRODUCTION Gallbladder perforation (GBP) is a rare but life threatening complication of acute cholecystitis. Sometimes GBP may not be different from uncomplicated acute cholecystitis with high morbidity and mortality rates because of delay in diagnosis[…     

Does a second resection provide a survival benefit in patients diagnosed with incidental T1b/T2 gallbladder cancer following cholecystectomy?

BackgroundIncidental T1b/T2 gallbladder cancers are often managed with a second resection. However it is unclear whether the additional surgical risk is associated with any survival advantage. The aim of this study was to examine the outcomes of patients who underwent a second resection following a diagnosis of incidental T1b/T2 gallbladder cancer.MethodsA retrospective analysis of patients undergoing surgical management following a diagnosis of incidental T1b/T2 gallbladder cancer between 1994 and 2014. Survival outcomes were analysed using the Kaplan–Meier method.ResultsTwenty two patients underwent completion surgery following diagnosis of T1b/T2 gallbladder cancer at initial cholecystectomy, 11 of which were found to have residual disease. The presence of residual disease at second surgery in T1b/T2 disease was associated with worse overall survival (residual disease: median survival 12 months, absence of residual disease: median survival not reached, p = 0.025).ConclusionA significant percentage of patients with T1b/T2 disease have identifiable residual disease following second surgery. Residual disease is associated with poor survival. It is therefore important to inform patients that completion cholecystectomy is primarily performed to inform staging rather than to improve prognosis.     

Diagnosis of gallbladder tumors

Gallbladder cancer is among the organs examined in mass screening for cancer using ultrasonography; the reported prevalence of gallbladder cancer in such screening of a general population was 0.011%, while the prevalence of gallbladder polyps was reported as 4.3 to 6.9%. Endoscopic ultrasonography is useful for the differential diagnosis of gallbladder tumors detected by mass screening, as well as for estimating the depth of tumor invasion and detecting abnormal connections between pancreatobiliary ducts. While a systematic approach leading to diagnosis by endoscopic ultrasonography is useful, recent advances of contrast-enhanced ultrasonography are expected to establish it as a new modality for early detection. At our hospital, 7 of 26 patients with abnormal connections between pancreatobiliary ducts developed gallbladder carcinoma (23.1%), and 7 of 48 patients with gallbladder carcinoma had abnormal connections between pancreatobiliary ducts (12.5%). Serial observation in patients with gallstones and prophylactic surgery in patients with abnormal connections between pancreatobiliary ducts are necessary.     

Regional lymphadenectomy strongly recommended in T1b gallbladder cancer

This article discusses the adequate treatment of early gallbladder cancer(T1a,T1b) and is based on published studies extending over nearly 3 decades.Randomized studies and meta analyses comparing different surgical treatments do not exist.The literature shows that in up to 20% of patients lymph node metastasis are found in T1b gallbladder cancer.Due to high malignancy with early angiolymphatic spread and resistance to chemotherapy and radiation on the one hand,and the relative low operative risk of extended...     

Mirizzi综合征16例诊治体会

目的 探讨Mirizzi综合征的临床特点,总结诊断和治疗经验,提高对其恶变的认识.方法 分析回顾临床所遇16例患者的诊治过程.结果 术前明确诊断率不高,手术方法比较多,Ⅰ型行胆囊切除或胆囊大部切除术,Ⅱ型行胆囊切除、胆管修补加T管引流术,Ⅲ型、Ⅳ型行胆囊切除、肝总管空肠吻合术.胆囊癌变者二期行胆囊癌根治术.结论mirizzi综合征术前明确诊断率不高,胆囊癌变的可能性较大,治疗应根据不同类型选择适当的手术方式,术中或术后应及时送病理检查,排除癌变.     

Presentation and surgical management of xanthogranulomatous cholecystitis

Background: Xanthogranulomatous cholecystitis(XGC) is a rare benign chronic inflammatory disease of the gallbladder that often presents as cholecystitis and most of the times requires surgical management. In addition, distinguishing XGC from gallbladder cancer preoperatively is still a challenge. The aim of the present systematic review was to outline the clinical presentation and surgical approach of XGC. Data sources: The present systematic review was designed using the PRISMA and AMSTAR guidelines. We searched MEDLINE, Scopus, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials(CENTRAL) and Google Scholar databases from inception until June 2020. Results: The laparoscopic cholecystectomy rate(34%) was almost equal to the open cholecystectomy rate(47%) for XGC. An important conversion rate(35%) was observed as well. The XGC cases treated by surgery were associated with low mortality(0.3%), limited intraoperative blood loss(58-270 m L), low complication rates(2%–6%), along with extended operative time(82.6–120 minutes for laparoscopic and 59.6–240 minutes for open cholecystectomy) and hospital stay(3–9 days after laparoscopic and 8.3–18 days after open cholecystectomy). Intraoperative findings during cholecystectomies for XGC included empyema or Mirizzi syndrome. In addition, complex surgical procedures, like wedge hepatic resections and bile duct excision were required during operations for XGC. Conclusions: XGC seemed to be a rare, benign inflammatory disease that presents similar features as gallbladder cancer. The mortality and complication rates of XGC were low, despite the complex surgical procedures that might be required in some cases.     

The Incidence of Abdominal and Pelvic Surgery Among Patients with Irritable Bowel Syndrome

Rates of abdominopelvic surgery, with a particular focus on gallbladder procedures, were measured in patients with irritable bowel syndrome (IBS) (n = 108,936) and compared with those in a general population sample (n = 223,082). The patient sample was selected from persons who were members of a managed care organization during the years 1995-2000. Medical records from a randomly selected subset of IBS patients were reviewed to confirm the diagnosis. Crude and standardized rates and adjusted rate ratios for surgery were calculated. The incidence of abdominopelvic surgery, excluding gallbladder procedures, was 87% higher in patients with IBS than that for the general population. The incidence of gallbladder surgery was threefold higher in IBS patients than the general population. Patients with IBS have an increased risk for abdominopelvic and gallbladder surgery and, thus, an associated risk for experiencing morbidity and mortality associated with these surgical procedures.     

Gallbladder carcinoma as an incidental finding]

Between March 1982 and December 1990, 903 patients underwent elective cholecystectomy. In 40 patients cholecystectomy was performed for gallbladder carcinoma. 15 malignomas (1.7%) were found incidentally. Preoperatively no anamnestic or diagnostic tumor signs were found in this group of patients. An en-bloc-resection of the gallbladder with resection of the bordering liver segments was performed when gallbladder carcinoma was diagnosed intraoperatively. When the diagnosis was established by postoperative histology, a relaparotomy with liver resection and lymphnode-dissection was done, except in one case (T-1a stage). Histology showed adenocarcinoma in 11 out of 15 cases. No significant difference in the course of the disease was observed in patients with gallbladder carcinoma of different types. The hospital mortality rate was 0% after curative and palliative surgical treatment of gallbladder carcinoma. Patients with T-1 and T-2 stage have survived without tumor-recurrence up to now. The median survival time after surgery for gallbladder carcinoma in T-3 stage was 17 months, and 8 months in T-4 stage. The morbidity rate after elective cholecystectomy is low and hospital mortality is 0%. According to the short survival times in advanced stages of gallbladder carcinoma, a prompt cholecystectomy in symptomatic gallbladder lithiasis or chronic cholecystitis is advocated.     

Gallbladder volvulus: review of the literature and report of a case.

Gallbladder volvulus is defined as the rotation of the gallbladder on its mesentery along the axis of the cystic duct and cystic artery. The presence of a redundant mesentery (floating gallbladder) is a prerequisite for volvulus. The disease, described for the first time by Wendel in 1898, is an extremely rare surgical disease. The disease mimics acute cholecystitis symptoms. Because of these two conditions, preoperative diagnosis of the disease is difficult. In any case, the definitive diagnosis is made during surgery. Volvulus of the gallbladder is an acute surgical emergency that must be treated with immediate detorsion and cholecystectomy. We report a case of gallbladder volvulus suspected pre-operatively using pre-operative imaging with ultrasound. The cases reported in the literature are reviewed and the treatment of gallbladder volvulus is also discussed.     

Surveillance of pre-malignant disease of the pancreatico-biliary system

Technical advancements in ultrasonography, contrast-enhanced computed tomography and magnetic resonance imaging, as well as the wider availability of these ultramodern imaging techniques, have resulted in the early detection and a better classification of various asymptomatic and symptomatic pancreatico-biliary lesions. Pre-malignant biliary and pancreatic lesions are rare disorders, and no clear data are available to define their malignant potential. Because of the lack of controlled epidemiological data, the time span for malignant transformation and its frequency cannot be defined in the majority of these lesions. Adenomyomatosis of the gallbladder and gallbladder polyps larger than 10 mm should be treated by cholecystectomy even in asymptomatic patients because of an increased risk of malignant transformation. Chronic cholangitis, primary sclerosing cholangitis and choledochal cysts are also pre-malignant conditions. The timing of surgery, once it is advised for a pre-malignant condition that is still benign, should, however, be individualized to the particular patient situation. In patients with chronic pancreatitis, surgery may be indicated for disease-related complications. In as much as chronic pancreatitis predisposes to a higher risk of pancreatic cancer, any suspicion of malignancy should warrant a surgical exploration. Intraductal papillary tumours and mucin-producing pancreatic tumours are other pre-malignant pancreatic lesions whose malignant potential cannot be precisely determined pre-operatively. They should be resected in situations where there is a high degree of suspicion even without a clear objective diagnosis. In conclusion, pre-malignant hepato-biliary and pancreatic lesions of uncertain pathology should undergo early resection in view of treatment limitations and the dismal prognosis of established cancers. While hepato-biliary and pancreatic surgery is nowadays performed in specialized centres, with a low post-operative morbidity and mortality, it is equally important to understand that observation alone with regular computed tomography or magnetic resonance imaging control can no longer be recommended in the management of these lesions.