摘要
目的探讨误诊为胆囊良性疾病的胆囊癌二次手术方式以及对预后的影响.方法对于1995年6月～2002年12月因误诊为胆囊良性疾病而切除胆囊,因术后病理证实为胆囊癌而二次行胆囊癌扩大根治术的41例患者进行回顾性分析.41例患者中,男12例,女29例,平均年龄51岁,均因胆囊炎(41例)或并发胆囊结石(32例)、胆囊息肉或腺瘤(9例)在第一次手术时行单纯胆囊切除.术后病理:胆囊腺癌32例,鳞癌6例,鳞腺癌3例;Nevin Ⅰ期6例,Ⅱ期16例,Ⅲ期17例,Ⅳ期2例,Ⅴ期0例.二次手术距一次手术间隔时间为6～30 d.二次手术均行以改良的Glenn根治性胆囊癌切除术为标准的胆囊癌根治术式.结果二次手术时发现14例患者有淋巴结转移,14例患者有胆囊床转移,6例患者有胆管转移,2例患者有胰腺转移;Nevin Ⅳ期14例,Ⅴ期9例,无Ⅰ、Ⅱ、Ⅲ期者.二次手术后1年后存活率100%(41例),3年存活率53.8%(22例),5年存活率17.5%(7例). 结论扩大根治术是治疗误诊为胆囊良性疾病的胆囊癌的重要方法之一.
Objective To investigate the secondary operation methods and the effects on the prognosis of unexpected gallbladder cancer (UGC). Methods A retrospective analysis on the clinical data was made for 41 patients who underwent extended radical excision from June 1995 to December 2002. Among the patients, 12 were male, 29 were female. The average age was 51 years old. The 41 patients had undergone gallbladder excision because of cholecystitis complicated lithiasis of gallbladder (32 cases), polypi of gallbladder or adenoma (9 cases). Postoperative pathology showed that 32 cases were adenocarcinoma of gallbladder, 6 cases were squamous carcinoma, 3 cases were squamous adenocarcinoma. Six cases were on the stage of Nevin I, 16 on Nevin II, 17 on Nevin III, 2 on Nevin IV. The second operation was performed after 6-30 d of the first operation. The second operation chose the improved method of Glenn excision of carcinoma of gallbladder. Results On the second operation, 14 cases were with lymphatic metastasis, 14 with gallbladder metastasis, 6 with bile duct metastasis, 2 with pancreas metastasis. Fourteen cases were on the stage of Nevin IV, 9 on Nevin V, none on Nevin I, II and III. After the second operation, 1 year survival rate was 100% (41 cases); The three -year survival rate was 53.8% (22 cases); The five-year survival rate was 17.5% (7 cases). Conclusion Extended radical excision is one of the most important methods for the treatment of UGC.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2005年第7期460-462,共3页
Chinese Journal of Surgery
