胆囊癌89例临床分析

目的 探讨提高胆囊癌疗效的途径。方法 对１９８５－１９９６年间收治的８９例胆囊癌患者的临床资料进行回顾性分析。结果 ８９例患者中男３１例，女５８例。男：女之比为１：１.８７。胆囊癌合并胆囊结石者占４０％，术前Ｂ超论断符合率为７９％（６２／７８）。ＣＴ诊断符合率为９２％（４３／４７），术中及术后病理确诊占１８％（１６／７７）。本组７例漏诊，７７例行探查手术，５０例切除胆囊。切除率６５％，其中根治 切除２８例，根治率３6％。本组行根治性切除者１、３、５年生存率分别为７７％、５４％和２７５；行姑息性切除者１、３、５年生存率分别为４１％、１２％和６％（与根治切除相比Ｐ均＜０.０５）。仅行探查术者中位生存期３个月，且均在１年内死亡。结论 早期发现和根治性手术是提高胆囊癌患者生存率的有效方法，避免术中漏诊对预后有重要意义，对晚期胆囊癌应行扩大根治术。

Surgical treatment of gallbladder carcinoma: result of 89 cases

Objective　 To improve the therapeutic result of gallbladder carcinoma.　 Methods　A retrospective clinical analysis was made in 89 cases of gallbladder carcinoma admitted from 1985 to 1996.　ResultsThere were 31 males and 58 females,　with M∶F=1∶1.87. 36(40%) patients were associated with gallstones.There were 62 (79%) cases definitely diagnosed by preoperative ultrasonography, and 43(92%) by CT. 16(18%) cases were diagnosed by laparotomy or pathology． 50 cases underwent cholecystectomy with a resection rate of 65%, and 28 cases (36%) received radical resection. Postoperative 1-,3-,5- years survival rate of radical and palliative resection were 77%, 54%,27% and 41%,12%,6% respectively (all P＜0.05). All cases undergoing biopsy only died within one year.　 Conclusions　Early diagnosis and radical resection are still the mainstay for long-term survival of the patients with gallbladder carcinoma. Prognosis could also be improved by avoiding intraoperative misdiagnosis. Extended radical resection should be attempted for advanced cases.