原发性胆囊癌43例分析.DOCVIP

临床医学论文-原发性胆囊癌43例分析 ???????? 作者：梁浩晖　王成友　张敏杰　倪勇 【摘要】? 目的? 总结原发性胆囊癌的治疗经验，探讨提高原发性胆囊癌生存率的方法。方法? 回顾性分析我院1995～2005年收治的43例胆囊癌病例的临床资料。结果? 43例患者中，男14例，女29例。B型超声与CT的确诊率分别为80.9%、85.7%。Ⅰ、Ⅱ期病例行单纯胆囊切除即可获得良好的生存率，其3年存活率为100%，5年存活率为75%，Ⅲ、Ⅳ期病例行根治术后2年存活率为46.2%，Ⅴ期病例术后存活多不超过1年。结论? B型超声与CT仍是诊断原发性胆囊癌的重要手段。手术是治疗原发性胆囊癌的首选方法，早期诊断和早期根治性手术是提高原发性胆囊癌患者生存率的关键。对有高危因素的患者，应早期行胆囊切除术。 　　【关键词】? 胆囊肿瘤; 外科手术;5年生存率??? 　　Surgical treatment of the primary gallbladder cancer in 43 cases 　　【Abstract】? Objective? To sum up the experience of the surgical treatment and to improve the prognosis of the primary gallbladder cancer.Methods? An analysis was made on 43 cases of gallbladder cancer in our hospital from 1995 to 2005, retrospectively.Results? There were 14 males and 29 females,there were 34 cases (80.9%) definitely diagnosed by preoperative ultrasonography, and 30(85.7%) by CT.Long-term survivals were achieved almost only in the cases of stage Ⅰ and Ⅱ with 3-year survival rate of 100% and 5-year survival rate of 75%. Two-year survival rate in stage Ⅲ and Ⅳ cases was 42.9% after radical cholecystectomy. Almost all stage Ⅴ cases died in 1 year postoperation.Conclusion? Ultrasonography and CT-scan were important to preoperative diagnosis. Surgical operation is the first choice of therapy. Early diagnosis and radical resection are still the main factors for long-term survival of the patients with primary gallbladder cancer. Cholecystectomy is recommended for high risk patients. 　　【Key words】? gallbladder neoplasm;surgical procedures;5-year survival rate ??? 原发性胆囊癌（primary gallbladder cancer）的早期诊断困难，手术切除率低，预后极差。近年来，随着诊断手段和治疗方法上的改进，对其预后有了一定的改善，但对晚期胆囊癌目前仍缺乏有效的治疗手段。本文就我院1995～2005年收治的43例胆囊癌患者的临床资料进行回顾性分析如下。 　　1? 资料与方法 　　1.1? 一般资料? 本组43例，男14例，女29例。年龄32～86岁，50岁以上者29例，占67.4%。临床表现无明显特异性，首发症状以右上腹疼痛多见，占72.1%（31/43）；其次为黄疸，占23.3%（10/43）；右上腹包块，占18.6%（8/43）；消瘦，占16.3%（7/43）；发热，占13.9%（6/43）；无症状者体检时发现2例。 　　1.2? 影像学检查? B型超声与CT检查是诊断本病的重要手段。本组42例行B型超声检查，诊断符合率为80.9%（34/42），其中31例合并胆囊结石，占73.8%。35例行CT检查，诊断符合率为85.7%（30/35）。10例行ERCP检查，