胆囊结石合并胃癌36例临床研究.docVIP

胆囊结石合并胃癌36例临床研究[摘要] 目的:提高胆囊结石合并胃癌的诊治水平。方法:收集胆囊结石合并胃癌患者36例,详细介绍该合并症的发病特点,分析延误诊治的原因,详述减少延误诊治的措施。结果:延迟诊断胆囊结石合并胃癌29例,延迟诊断率为80.6%。结论:胆囊结石慢性胆囊炎患者可能会合并胃部病变,认真分析病史及临床资料,是合并胃癌患者早发现、早诊断、早治疗的关键,以免延误诊治,影响疗效。 [关键词] 胆囊结石;胃癌;临床分析 [中图分类号] R657.4 [文献标识码]B[文章编号]1673-7210(2009)08(a)-255-02 Clinical analysis of 36 cases of gastric cancer associated with gallbladder FANG Canjun1*, XU Linsheng2 (1.Anqing Medical and Pharmaceutical College, Anqing 246000, China; 2.Department of Digestion, Navy Anqing Hospital, Anqing 246003, China) [Abstract] Objective: To enhance the treatment level of gastric cancer associated with gallbladder. Methods: 36 cases of gastric cancer associated with gallbladder were collected, the incidence characteristic was described in detail, the causes of delayed treatment was analyzed, the measures to reduce the delay in treatment was described in detail. Results: Delayed diagnosis 29 cases of gastric cancer associated with gallbladder, the rate of delayed diagnosis was 80.6%. Conclusion: Gallstone patients with chronic cholecystitis may be merged stomach lesions, a careful analysis of history and clinical information is combined in patients with gastric cancer early detection, early diagnosis, early treatment key to avoid any possible delay in diagnosis and treatment, the impact of efficacy. [Key words] Gallstones; Gastric cancer; Clinical analysis 近年来,胆囊结石与胃癌并存的关系已为临床医生所重视。随着胆囊结石发病率的增加,发现其中一些患者合并胃癌。我院1992～2007年共收治胆囊结石合并胃癌患者36例,现报道如下: 1资料与方法 1.1一般资料 我院1992～2007年共收治36例胆囊结石与胃癌并存病例。其中,男性14例,女性22例,男∶女=1∶1.6;年龄45～77岁,平均63岁,以50～65岁为最多(22例),50岁以下5例,65岁以上9例。36例既往均有胆囊炎胆绞痛发作史,药物治疗症状缓解。 1.2 临床表现及诊断 36例无典型的急性胆囊炎临床症状,主要是以反复发作的上腹部或右上腹隐痛、饱胀不适表现为主。病史多在10年以上,药物治疗效果不明显,同时伴有反酸、嗳气22例,恶心、呕吐15例,消瘦3例,消化道出血8例。术前经各项检查确诊为胃癌26例,胆囊术中探查发现病理证实6例,另4例在胆囊切除半年后,因仍有上腹不适经再次检查发现。 1.3 治疗方法 1.3.1 术式接受手术的36例患者中,发现大部分患者的胆囊呈慢性炎症改变。胆总管探查4例,胆囊横结肠瘘修补2例。行根治性远端胃切除B1式吻合18例,根治性近端胃切除食管吻合4例,根治性全胃切除食管空肠Roux-en-Y吻合8例,6例因胃癌已发生腹腔内其他脏器转移而行姑息治疗,手术后的标本均送病理检查。 1.3.2 胃癌的TNM分期与病理