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目的 分析我院近20年胆囊癌病例,为提高胆囊癌的诊治水平提供一些经验。方法 回顾1983年1月-2001年11月间有病理报告证实的胆囊癌127例,前10年58例,后8年69例,对比前后10年间的诊断与治疗方法,以及患者的预后。结果 前10年的术前诊断率为29.3％,术后病理诊断率18.9％。后8年分别为60.9％、4.3％,与前10年相比P<0.01。全组NevinⅠ、Ⅱ期的患者共13例,行单纯胆囊切除术,随访3年均生存。Ⅲ期以上患者前10年的54例,行标准胆囊癌根治术,术后未做其他治疗。其术后1、3年生存率分别为的64.8％、24.1％。后8年60例,根治手术率达38.3％（P<0.05）,术后1、3年生存率分别为71.7％（P>0.05）及43.3％（P<0.05）。本组无腹腔感染、胆漏、肝肾功能衰竭等严重术后并发症,无手术死亡。结论 胆囊癌起病隐匿,与有多年的慢性胆囊炎、胆囊结石病史有关;B超及CT检查可提高胆囊癌术前诊断率。术中对胆囊局部增厚、变硬或隆起性病变做冰冻检查,是防止漏诊的必要手段。胆囊癌根治术是提高患者1、3年生存率的有效方法。
Objective To analyze the cases of gallbladder cancer in our hospital for nearly 20 years and provide some experiences to improve the diagnosis and treatment of gallbladder cancer. Methods From January 1983 to November 2001, there were 127 cases of gallbladder carcinoma confirmed by pathology report, 58 cases in the first 10 years and 69 cases in the later 8 years. The diagnostic and treatment methods were compared between before and after 10 years and the prognosis of the patients. Results The preoperative diagnosis rate in the first 10 years was 29.3% and postoperative pathological diagnosis rate was 18.9%. After 8 years were 60.9%, 4.3%, P <0.01 compared with the previous 10 years. A total of 13 patients with Nevin Ⅰ and Ⅱ stages were treated with simple cholecystectomy and were followed up for 3 years. In the first 10 years of stage Ⅲ, 54 patients underwent radical gastrectomy, and no other treatment was done after the operation. The 1-year and 3-year survival rates were 64.8% and 24.1% respectively. Six months after operation, the radical operation rate reached 38.3% (P <0.05) and the one and three year survival rates were 71.7% (P> 0.05) and 43.3% (P <0.05) respectively. No abdominal infection in this group, bile leakage, liver and kidney failure and other serious postoperative complications, no surgical death. Conclusion The occult onset of gallbladder carcinoma is related to the history of chronic cholecystitis and gallstones for many years. The diagnosis of gallbladder carcinoma by B ultrasound and CT can improve the preoperative diagnosis rate. Intraoperative gallbladder local thickening, hardening or protuberance disease to do frozen check is necessary to prevent misdiagnosis. Gallbladder cancer radical surgery is to improve patients 1, 3-year survival rate of effective methods.