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目的研究意外胆囊癌的临床病理特征,寻找胆囊癌的早期诊断措施。方法回顾分析腹腔镜胆囊切除术中意外发现的36例意外胆囊癌患者的临床病理特征。结果女性多见,占77.8%,>60岁患者占69.4%;病程>5年的患者占66.7%;临床症状多不明显,与胆囊炎、胆结石和胆囊息肉的临床表现相似。病灶位于胆囊底15例,胆囊体14例,胆囊颈7例;结节状肿块9例,胆囊壁局限性或弥漫性增厚、黏膜粗糙24例,胆囊壁出血坏死未见明显肿块3例。36例意外胆囊癌均为腺癌,高分化9例,中分化20例,低分化5例,未分化2例。肿瘤以Nevin分期:Ⅰ期9例(25.0%),Ⅱ期8例(22.2%),Ⅲ期10例(27.8%),Ⅳ期6例(16.7%),Ⅴ期3例(8.3%)。结论对胆囊结石、慢性胆囊炎和胆囊息肉患者,尤其是老年女性患者和病程较长患者的术前检查和正确治疗,是早期发现和预防意外胆囊癌的重要措施。
Objective To study the clinicopathological features of unexpected gallbladder cancer and to find out the early diagnosis of gallbladder cancer. Methods The clinical and pathological features of 36 patients with unexpected gallbladder carcinoma discovered during laparoscopic cholecystectomy were retrospectively analyzed. Results Female were more common, accounting for 77.8%, patients aged> 60 years accounted for 69.4%; patients with disease> 5 years accounted for 66.7%; clinical symptoms were not obvious, and the clinical manifestations of cholecystitis, gallstones and gallbladder polyps were similar. The lesions were located at the end of the gallbladder in 15 cases, gallbladder in 14 cases, gallbladder neck in 7 cases; nodular mass in 9 cases, limited or diffuse gallbladder wall thickening, mucosal rough in 24 cases, gallbladder hemorrhage and necrosis no obvious mass in 3 cases. 36 cases of gallbladder cancer were adenocarcinoma, 9 cases of well-differentiated, moderately differentiated in 20 cases, poorly differentiated in 5 cases, undifferentiated in 2 cases. The Nevin stage of the tumor was 9 cases (25.0%) in stage Ⅰ, 8 cases (22.2%) in stage Ⅱ, 10 cases (27.8%) in stage Ⅲ, 6 cases (16.7%) in stage Ⅳ and 3 cases (8.3%) in stage Ⅴ. Conclusion Preoperative examination and correct treatment of patients with gallstones, chronic cholecystitis and gallbladder polyps, especially elderly women and patients with longer course of disease are important measures for early detection and prevention of unexpected gallbladder cancer.