中晚期胆囊癌的外科治疗策略:附17例报告

目的 探讨中晚期胆囊癌(NevinⅢ～Ⅴ期)的外科治疗方法,进一步提高患者存活时间.方法 结合文献,联系17例中晚期胆囊癌的围手术期临床资料及随访数据,着重从患者术前诊断、手术治疗策略、术后并发症及存活时间等方面进行探讨.结果 通过术前多种影像学资料相互印证,可以诊断中晚期胆囊癌并对分期做出判断,但是不能避免误诊;手术治疗中晚期胆囊癌的要点在于手术范围的确定,特别是淋巴结彻底清扫的程度,本组13a淋巴结阳性率35.3%;8淋巴结阳性率23.5%,说明为了尽量保证肿瘤无残留必要时可适当扩大手术范围;手术后并发症主要包括腹腔感染、胆瘘和麻痹性肠梗阻.结论 中晚期胆囊癌外科治疗需要适当手术范围,术中肿瘤无残留可以使患者存活较长时间.

Abstract：

Objective To explore the optimal surgical treatment strategy of advanced gallbladder carcinoma (Nevin Ⅲ - Ⅴ ), with an aim to prolong patients' overall survival. Methods 17 patients with advanced gallbladder carcinoma were reviewed. Their preoperative diagnosis, surgical treatment, complications and survival time were studied. Results The diagnosis of advanced gallbladder carcinoma was done using different medical imaging techniques, but incorrect diagnosis still happened. There is a wide range of surgical treatment for advanced gallbladder carcinoma. Controversy still exists as whether lymph node resection should be done. In our patients, 35.3% of the 13a lymph nodes and 23. 5% of the 8 lymph nodes were positive for metastasis, which showed that lymph node resection should be carried out. Extended surgery was sometime required to ensure a R0 resection.The main complications of surgery were intraabdominal infection, bile leakage and paralytic ileus.Conclusion An aggressive surgical approach for advanced gallbladder carcinoma is required to ensure a R0 resection, which contributed to better overall survival.

Surgical treatment strategy of advanced gallbladder carcinoma: report on 17 cases

Objective To explore the optimal surgical treatment strategy of advanced gallbladder carcinoma (Nevin Ⅲ - Ⅴ ), with an aim to prolong patients' overall survival. Methods 17 patients with advanced gallbladder carcinoma were reviewed. Their preoperative diagnosis, surgical treatment, complications and survival time were studied. Results The diagnosis of advanced gallbladder carcinoma was done using different medical imaging techniques, but incorrect diagnosis still happened. There is a wide range of surgical treatment for advanced gallbladder carcinoma. Controversy still exists as whether lymph node resection should be done. In our patients, 35.3% of the 13a lymph nodes and 23. 5% of the 8 lymph nodes were positive for metastasis, which showed that lymph node resection should be carried out. Extended surgery was sometime required to ensure a R0 resection.The main complications of surgery were intraabdominal infection, bile leakage and paralytic ileus.Conclusion An aggressive surgical approach for advanced gallbladder carcinoma is required to ensure a R0 resection, which contributed to better overall survival.