肝胆胰外科杂志 ›› 2020, Vol. 32 ›› Issue (11): 655-658.doi: 10.11952/j.issn.1007-1954.2020.11.004

• 意外胆囊癌专题 • 上一篇    下一篇

87例意外胆囊癌多中心诊疗分析

杨晓平1 ，韩江2 ，丁友成3 ，王永兵4 ，陶国强5 ，赵滨6
  

  1. 1.上海市浦东医院/复旦大学附属浦东医院 普外科，上海 201399；2.上海市健康医学院附属周浦医院普外科，上海 201318；3.同济大学附属东方医院 肝胆外科，上海 200120；4.上海健康医学院附属浦东新区人民医院 普外科，上海 201299；5.上海市浦东新区浦南医院 普外科，上海 200125；6.上海中医药大学附属第七人民医院 普外科，上海 200135
  • 收稿日期:2020-11-12 出版日期:2020-11-15 发布日期:2020-11-23
  • 通讯作者: 赵滨，主任医师，硕士，E-mail：zhaobin0727@sina.com。
  • 作者简介:杨晓平（1975-），男，浙江台州人，主任医师，博士。
  • 基金资助:
    上海市浦东新区卫生系统学科带头人培养计划（PWRd2016-04）；复旦大学附属浦东医院重点专科专病诊治中心项目资助（Zdzk2020-09）。

Diagnosis and treatment of incidental gallbladder carcinoma in 87 cases: a multicenter retrospective study 

YANG Xiao-ping1 , HAN Jiang2 , DING You-cheng3 , WANG Yong-bing4 , TAO Guo-qiang5 , ZHAO Bin6
  

  1. 1 Department of General Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai 201399, China; 2 Department of General Surgery, Zhoupu Hospital Affiliated to Shanghai University of Medicin & Health Sciences, Shanghai 201318, China; 3 Department of Hepatobiliary Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China; 4 Department of General Surgery, Shanghai University of Medicine & Health Sciences Affiliated Pudong New Area People’s Hospital, Shanghai 201299, China; 5 Department of General Surgery, Punan Hostipal, Pudong New District, Shanghai 200125, China; 6 Department of General Surgery, Shanghai Seventh People’s Hospital Affliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200135, China
  • Received:2020-11-12 Online:2020-11-15 Published:2020-11-23

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摘要：

目的 分析多中心意外胆囊癌（IGBC）病例治疗现状，探讨IGBC的诊断与治疗要点。方法 回顾性分析2013年1月至2020年6月上海市浦东新区6家医院收治的87例IGBC患者临床资料，男27例（31.03%），女60例（68.97%）；年龄34～89岁，平均68岁。术前诊断为胆囊结石伴胆囊炎67例，其中合并胆总管结石9例；胆囊息肉4例；胆囊腺肌症5例；胆囊结石合并胆囊息肉8例；慢性胆囊炎2例。术前87例患者均行B超检查；26例行CT检查，其中6例发现胆囊壁局部或不规则增厚；术前行肿瘤标志物检测52例，CA199升高7例（67～238 kU/L）。结果 同期6家医院行腹腔镜胆囊切除术（LC）16 411例，IGBC占比0.53%；同期胆囊癌根治术219例，IGBC占比39.73%。87例IGBC中，急诊LC 25例（28.74%），择期LC62例（71.26%）；术中冰冻病理发现IGBC 70例，术后常规病理发现IGBC 17例；行胆囊癌根治术65例，未行根治术22例。术后病理检查，Tis期15例，T1期20例，T2期28例，T3期22例，T4期2例。45例获得随访，随访时间3～96个月，中位时间26个月。T分期越早，生存期越长（P=0.01039），根治性手术明显改善患者的生存期（P=0.00423）。结论 意外胆囊癌应从胆囊良性疾病的规范化诊治角度入手防治，才能减少其发生；根治手术能提高意外胆囊癌患者术后的生存期。

关键词:

Abstract:

Objective To analyze the treatment status of incidental gallbladder carcinoma (IGBC), to explore the diagnosis and treatment main points of IGBC. Methods The clinical data of 87 patients with IGBC admitted to 6 hospitals in Pudong New Area from Jan. 2013 to Jun. 2020 were analyzed retrospectively. There were 27 males (31.03%) and 60 female (68.97%), with average age 68 years (range 34 to 89 years). Preoperative diagnosis of cholecystolithiasis with cholecystitis in 67 cases, among them 9 cases plus choledocholithiasis; gallbladder polyp in 4 cases; gallbladder adenomyos in 5 cases; gallstone plus gallbladder polyp in 8 cases; chronic cholecystitis in 2 cases. B ultrasound examination was performed in 87 patients before operation; CT examination was performed in 26 cases; local or irregular thickening of gallbladder wall was found in 6 cases; tumor markers were detected in 52 cases before operation, CA199 elevated in 7 cases (67~238 kU/L). Results During the same period, 16 411 cases received laparoscopic cholecystectomy (LC) in 6 hospitals, and IGBC accounted for 0.53%; 219 cases received radical cholecystectomy, and IGBC accounted for 39.73%. Among 87 IGBC, emergency LC was underwent in 25 cases (28.74%), and selected LC was underwent in 62 cases (71.26%); 70 cases were diagnosed by intraoperative frozen pathology, other 17 cases were diagnosed by routine pathology after operation. A total of 65 patients received radical resection of gallbladder carcinoma. Postoperative pathological examination showed 15 cases in Tis stage, 20 cases in T1 stage, 28 cases in T2 stage, 22 cases in T3 stage and 2 cases in T4 stage. Forty-five patients were followed up, time ranged from 3 to 96 months, with median time 26 months. The earlier tumor T stage, the longer survival time (P=0.01039); radical resection of gallbladder carcinoma improved the survival time of IGBC patients significantly (P=0.00423). Conclusion The diagnosis and treatment of gallbladder benign diseases should be standardized, so that to reduce the occurrence of IGBC. Radical resection of gallbladder carcinoma can improve the postoperative survival of patients with IGBC.

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中图分类号: 

  • R735.8
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[9] 范育林, 盛华嵩, 张劲松, 丁蒙福, 唐为志, 鲍恩武, 王敬民, 徐义仁. 腹腔镜胆囊切除术意外胆囊癌58例诊治分析[J]. 肝胆胰外科杂志, 2018, 30(4): 303-305.
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