原发性胆囊癌诊治的若干问题探讨

目的 探讨原发性胆裳癌的诊断与手术治疗。方法 回顾性分析19例胆囊癌患者的临床资料，并结合有关丈献分析原定性胆素癌（PGC）的高危因素及诊治特点、意外性胆囊癌（UGC）及针孔切口种植转移（PSM）。结果 夺组合并胆囊结石12例，占63．16％（12／19），术前确诊率为63．16％（12／19），联合B超及CT的诊断符合率91．67％（11／12），手术切除率47．37％（9／19）。腹腔镜胆囊切除术（LC）后UGC发生率0．11％（2／1866），常规剖腹胆囊切除术（OC）后UGC发生率0．26％（1／383），总LGC发生率为0．13％（3／2249），LC术后PSM发生卒0．05％（1／1866）。定期随访3个月至5年不等，平均生存时间为2．4年。结论 B型超声联合CT是术前较有效的诊断方法，防止UGC漏诊的有效方法是术中常规胆囊冰冻病理及全胆囊病理检查，治疗首选胆囊癌根治术。

Several important issues on diagnosis and treatment of primary gallbladder carcinoma

Objective To explore the diagnosis and surgical treatment of primary gallbladder carcinom(aPGC). Methods By way of the retrospective clinical analysis of 19 cases of PGC, some details combined with related literature were construed involving high dangerous factor, clinical characteristic, unexpected gallbladder carcinoma(UGC) and port site metastasis (PSM) about PGC. Results Twelve cases with gallbladder ston(e63.16%) in the group; 12 cases of PGC were confirmed according to clinical behave, computed tomography(CT) and B-ultrasonography (B-US). Preoperative diagnostic rate were 63.16(%12/19), operative resection rate were 47.37%(9/19). Two cases of UGC encountered during 1866 cases of laparoscopic cholecystectom(yLC)(0.11%); one of 383 cases with open cholecystectomy (OC)(0.26%), and overall rate of UGC of LC and OC were 0.13%(3/2249). one of PSM during 1866 cases of L(C0.05%) were observed. Following-up for three months to five years, the average survival time were 2.4 years. Conclusion B-US and CT are the main methods in early diagnosis of PGC. The entirely resected gallbladder should be routinely examined and frozen-section examination in order to avoid pretermission. Once PGC is diagnosed, radical resection is the best choice.