胆囊癌肝转移外科治疗的体会(附31例报告)

目的：探讨胆囊癌肝转移的手术治疗原则。方法：本组男１０例，女２１例，年龄３６～７６岁，均经病理证实为胆囊癌。８例行胆囊切除＋肝段切除＋淋巴结廓清的根治性手术，其中一例附加胰头十二指肠切除；姑息胆囊切除４例，姑息性旁路引流手术１０例，姑息胆囊切除加旁路引流手术３例，开腹探查术６例。结果：８例根治手术平均生存１５个月，３例至今仍存活。２３例未行根治手术者随访２１例，存活均未超过６个月。结论：胆囊癌肝转移病人选择性施行胆囊切除＋肝部分切除＋淋巴结廓清，必要时附加肝外胆管切除可取得较为满意的疗效。根治手术的关键是准确判断切缘。不能根治切除者，应尽可能行胆囊姑息切除或旁路手术。

Surgical Treatment of Advanced Gallbladder Carcinoma Metastasized to the Liver

Objective: To investigate the principle of surgical treatment for advanced gallbladder carcinoma metastasized to the liver. Methods: Thirty-one cases of pathologically confirmed gallbladder carcinoma were treated, including 10 male and 21 female, with ages ranging from 36 to 76 years. Eight cases underwent cholecystectomy plus partial liver resection and radical lymphadenectomy, 1 of which was further combined with pancreatoduodenectomy; 4 cases were subjected to cholecystectomy alone; 10 cases to bypass procedure alone; 3 cases to cholecystectomy combined with bypass procedure, and 6 cases underwent exploratory laparotomy. Results: Patients with radical surgery survived for 15 months in average and 3 cases still remain alive. Among those who were treated with palliative surgery, 21 cases were followed-up, none survived for longer than 6 months. Conclusions: Cholecystectomy combined with partial liver resection and radical lymphadenectomy, with or without resection of the extrahepatic bile duct is the method of choice whenever judged feasible. Otherwise, palliative cholecystectomy and/or bypass procedures should be adopted.