胆囊癌141例临床分析

目的探讨胆囊癌的诊治方法。方法回顾性分析我院1992年10月~2002年10月141例胆囊癌病人的临床资料。诊断采用术中探查、即时冷冻切片及影像学检查等方法。治疗采用根治性手术、二次手术、复发再手术等综合性手段。结果术前确诊87例。其中,有12例未作手术。术前未予确诊的54例,经手术或冷冻切片确诊42例,术后病理切片证实12例。随访97例。住院期内共死亡15例,出院3个月内死亡32例。累计存活1年以上者34例,3年者10例,5年者6例。其中,存活5年及5年以上者均为术后病理发现而行二次根治手术者。结论胆囊癌的诊断易受结石、黄疸、炎症等影响。术中疏忽和未作冰冻切片可影响术中再诊断和恰当的治疗。根治性手术、二次手术及复发再手术可提高胆囊癌病人的生存率。

Clinical analysis on 141 cases of gallbladder carcinoma

ObjectiveTo discuss diagnosis and treatment of gallbladder carcinoma.MethodsThe clinical data of 141 cases of gallbladder carcinoma from Oct.1992 to Oct.2002 were retrospectively analyzed.Methods of diagnosis included intraoperative exploration,immediately frozen section iso-methods and image diagnostics.Therapies included radical operation,second operation and re-operation after recurrence.ResultsOf all the 141 patients,87 cases(61.7%)obtained confirmative diagnosis preoperatively.12 cases were not subjected to surgical operation.In 54 cases without preoperative confirmative diagnosis,42 cases obtained confirmative diagnosis surgical operation or frozen sections,and 12 cases by pathological section observation postoperatively.Ninety-seven cases were followed up.Fifteen cases died during hospitalization and 32 cases died 3 months after leaving hospital.After operation,1-,3-,5-year survival rate was 24.4%,7.3% and 4.3% respectively.The patients whose survival time was 5 years and over were those who obtained pathological diagnosis and subjected to second radical operation.ConclusionDiagnosis of gallbladder carcinoma is affected by lithiasis,inflammation,jaundice and so on.Carelessness and no frozen section iso-methods during operation can influence the re-diagnosis and appropriate therapeutics.Redical operation,second operation and re-operation after recurrence can raise survival rate of the patients with gallbladder carcinoma.