胆囊癌28例临床分析.DOCVIP

临床医学论文-胆囊癌28例临床分析 【摘要】 目的? 分析提高胆囊癌疗效的途径。 方法? 对1994～2003年间收治的28例胆囊癌患者进行回顾性临床分析。 结果? 术前确诊率仅为53.6%（15/28），手术切除率为71.4%（20/28），单纯胆囊切除术6例（占21.4%），胆囊切除+总胆管探查4例（占14.3%），胆囊切除+区域淋巴结清扫2例（占7.1%），胆囊+肝楔状切除+区域淋巴结清扫6例（占21.4%），胆囊+肝楔状切除+区域淋巴结清扫+右半结肠切除1例（占3.6%），胆囊+肝楔状切除+区域淋巴结清扫+胃大部切除+右半结肠切除1例（占3.6%），未切除率为28.6%，胃-空肠吻合术2例（占7.1%），胆囊造瘘1例（占3.6%），仅做剖腹探查术5例（占17.9%）。本组总的5年存活率10.7%（3/28），约60.7%（17/28）的患者手术后1年内死亡。 结论? 目前临床发现的胆囊癌极大部分属于中、晚期，疗效令人失望。提高疗效的途径在于早期发现和处理胆囊癌高危病变，预防胆囊癌形成。强调避免术中漏诊对预后的重要性，手术切除是最佳选择。 ??? 关键词? 胆囊癌 诊断 治疗 ??? Clinical analysis of gallbladder carcinoma in28cases ??? 【Abstract】 Objective To improve the therapeutic efficacy of gallbladder carcinoma.Methods A retrospec-tive clinical analysis was made in28cases of gallbladder carcinoma，who were admitted to treat in our hospital between1994and2003.Results Preoperative diagnostic rate was53.6%，and operative resection rate was71.4%，simple cholecystectomy in6cases，cholecystectomy and exploration of the biliary passage in4cases，gallbladder and regional lymphadonectomy in2cases，gallbladder and liver wedge resection and regional lymphadonectomy in6cases，gallblad-der and liver wedge resection and regional lymphadonectomy and right hemicolectomy in1case，and gallbladder and liver wedge resection and regional lymphadonectomy and subtotal gastrectomy and right hemicolectomy in1case.Unre-sectable rate were28.6%，gastro-jejunostomy in2cases，cholecystostomy in1case.Laparotomy exploration only in5cases.The5-year survival rate in this series was10.7%.About60.7%of the patients died longer than1year after operation.Conclusion Currently，most patients with gallbladder carcinoma are of middle to late stages on admission.The therapeutic efficacy is still not satisfactory.Pathological finding and resection of the high-risk factors for gallblad-der carcinoma on time could prevent formation of gallbladder carcinoma.It is very important to avoid misdiagnosis dur-ing operation for prognosis.Operative resection is the best choice. ??? Key words gallbladder carc