原发性胆囊癌的预后与病理和手术类型的关系

目的 探讨提高原发性胆囊癌的治疗效果。方法 对１９８１年１月－１９９５年１２月收治的经病理证实的原发性胆囊癌６６例的临床及随访资料进行分析。结果 ６２％的病例合并有胆囊结石，右上腹疼痛，黄疸及右上腹包块是最常见的症状和体征。Ｂ超和ＣＴ有助于术前诊断。病理检查显示腺癌占７９％，早期肿瘤细胞分化程度相对较好，晚期肿瘤占６９％。５２％的病例病灶已无法切除，根治性手术仅占１６％，少数晚期患者经根治性手术可以获得长期生存。统计学分析显示肿瘤的病理分期、肿瘤细胞分级、手术方式与预后显著相关。结论 重视胆囊癌的诊断，适当扩大早期胆囊癌的手术切除范围，对晚期胆囊癌尽可能行根治性切除术，可望改善其预后。

The relationship between the prognosis and pathology or operation type of primary carcinoma of the gallbladder: a report of 66 cases

Objective　 To explore how to improve the prognosis of primary carcinoma of the gallbladder.　 Methods　 Sixty-six cases admitted into Ruijin Hospital from January 1981 to December 1995 were followed up. Diagnosis was confirmed pathologically in all cases, among them 48 were female and 18 male. The age ranged from 32 to 84 years old with a mean of 64. Sixty-two percent of the patients were associated with gallstones. Right upper quadrant pain, jaundice and abdominal mass were their major clinical manifestations. Ultrasonography and CT scan were helpful for preoperative diagnosis.　 Results　 Pathology revealed adenocarcinoma in 79% of the cases. Early cancer had good differentiation and radical resection was performed in only 16% of the cases. Long-term survival after radical resection could be achieved in some late cases. The prognosis of gallbladder carcinoma was statistically influenced not only by staging and grading of the tumor but also by the surgical procedure.　 Conclusions　 Attaching importance to diagnosis, extended surgery for early cancer and radical operation for late case may help in making the prognosis better.