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目的 评估上海市胆道癌的诊治情况。方法 对上海市区1997年6月至2001年5月4年间年龄在35~74岁的658例胆道癌新病例进行流行病学调查,对收集到的390例胆囊癌、195例胆管癌和73例壶腹癌的临床资料进行分析。结果 资料显示,胆道癌好发于老年人;胆囊癌男女之比为1∶2 61;胆管癌和壶腹癌则男性略多于女性。胆囊癌、胆管癌和壶腹癌分别有68 .5%、43 1%和22. 4%的患者合并胆结石。胆囊癌的B超诊断准确率为63 1%,意外胆囊癌占20%,ⅣA和ⅣB期胆囊癌占43. 6%。胆管癌和壶腹癌的误诊率较高,分别为19 1%和47 1%,且就诊时大多数患者已出现黄疸。69例(18 .2% )胆囊癌、50例(25 6% )胆管癌和54例(74% )壶腹癌行根治性切除术,术后1、3、5年生存率分别为58 .5%、42 .8%、40 .7%, 58%、28. 3%、11. 1%和81. 5%、39. 2%、26. 9%。79例胆管癌行姑息性引流术,大多数患者在术后1年内死亡。38例胆管癌植入金属内支架或塑料内支撑管,平均生存期约7个月。结论 胆道癌的早期诊断仍较困难;应重视胆囊癌手术方法的规范化;怀疑胆管癌而无手术禁忌证宜手术探查;壶腹癌宜行胰十二指肠切除术。
Objective To evaluate the diagnosis and treatment of biliary tract cancer in Shanghai. Methods A total of 658 new cases of biliary tract cancer aged 35-74 years from June 1997 to May 2001 in Shanghai were enrolled for epidemiological investigation. 390 cases of gallbladder cancer, 195 cases of cholangiocarcinoma and 73 cases of cholangiocarcinoma were collected. Cases of ampulla of clinical data analysis. Results data show that biliary tract cancer occurs in the elderly; gallbladder cancer male to female ratio of 1: 2161; cholangiocarcinoma and ampulla cancer is slightly more men than women. Gallbladder, cholangiocarcinoma and ampulla were 68.5%, 43.1% and 22.4% of patients with gallstones. The diagnostic accuracy of B-ultrasonography for gallbladder cancer was 63.1%, with 20% of unexpected gallbladder carcinomas, and 43. 6% of gallbladder carcinomas of stage IVA and IVB. Misdiagnosis rates of cholangiocarcinoma and ampullary carcinoma were higher, 19.1% and 47.1%, respectively, and jaundice was observed in most of the patients at the time of diagnosis. 69 cases (18.2%) had gallbladder carcinoma, 50 (25.6%) cholangiocarcinoma and 54 (74%) ampullary carcinoma underwent radical resection. The 1,3 and 5 year survival rates were 58 and 58 respectively. 5%, 42.8%, 40.7%, 58%, 28.3%, 11.1% and 81.5%, 39.2%, 26.9%. 79 cases of cholangiocarcinoma underwent palliative drainage, most of whom died within 1 year after operation. Thirty-eight cases of cholangiocarcinoma were implanted with metal stent or plastic stent, with an average survival of about 7 months. Conclusion Early diagnosis of biliary tract cancer is still more difficult; should pay attention to the standardization of surgical methods of gallbladder cancer; suspected cholangiocarcinoma without surgical contraindications should surgical exploration; ampullary carcinoma should pancreaticoduodenectomy.