原发性胆囊癌误诊19例研究.docVIP

原发性胆囊癌误诊19例研究作者简介:杨兴建(1966年-),男,四川省开江县人,医学学士,副主任医师,主研方向:普通外科和腹腔镜外科。? 【摘要】目的:提高原发性胆囊癌早期诊断率。方法:回顾性分析本院过去32例胆囊癌的诊治经过,并进行总结。结果:19例中14例误诊为慢性胆囊炎(或)合并胆囊结石,2例误诊为胆管结石,3例误诊为胆囊息肉。病理检查为:腺癌17例,乳头状腺癌1例,粘液腺癌1例。全部临床治愈,生存3-24(平均10.8)月。结论:高危人群(胆囊巨大结石、多发结石、胆囊息肉、胆囊萎缩、钙化等)全面检查,包括彩超、CT、MIR,特别是注重胆囊癌前病变的处理,必要时术中冰冻切片检查。? 【关键词】胆囊癌;误诊;原因? doi:10.3969/j.issn.1006-1959.2010.09.024文章编号:1006-1959(2010)-09-2323-02? Reason Analyses in Misdiagnosing Primary Carcinoma of the Gall Bladder Based on 19 missed casesYANG Xing-jianShuangliu No.1 People’s Hospital,Sichuan 610200,China? 【Abstract】Objective:To improve accuracy of diagnosing primary carcinoma of the gall bladder.Methods:First,review the whole curative process based on 32 cases.Then,analyze the reasons for incorrect diagnosis to make a summing-up report.Results:14 out of 19 missed cases were misdiagnosed as chronic cholecystitis or chronic cholecystitis mixed with gall bladder stones;other 2,biliary duct stones;another 3,gall bladder polyp.In the way of pathological examination, we found the truth was that 17 persons developed glandular cancer;1 person,nipple-like glandular cancer and 1 person,muciparous glandular cancer.Through clinical treatment,the 19 patients were completely restored to health. They lived 3 up to 24 months (the average is 10.8 months).Conclusion:For high-risk patients with huge gall bladder stones、multiple stones、gall bladder polyp、atrophy of the gall bladder、calcified gall bladder and so on,it is a must to have them completely examined employing various ways such as CT、MIR and color soma scope.Meanwhile,it is also critical to treat the precancerous lesion timely and correctly.If necessary,frozen section should be examined while the operation is being carried out.? 【Key words】Carcinoma of the Gall Bladder;Misdiagnosing;Reasons 原发性胆囊癌是指胆道系统常见的恶性肿瘤之一,据调查原发性胆囊癌占消化系统恶性肿瘤发病率的第五位。由于原发性胆囊癌发生时的症状体征不明显,也不具有特异性,所以其早期诊断率较低,且病情发展较快,预后差。我院收治的原发性胆囊癌32例患者,均经手术、病理检查证实。其中手术前误诊19例患者,误诊率为59.4%。为提高广大医疗患者对本病的进一步认识,现将临床资料和