意外胆囊癌漏诊及防治.doc

意外胆囊癌漏诊及防治 　 作者：高永忠 金唐林 施维锦　 【摘要】 目的 探讨意外胆囊癌的漏诊产生原因、防治措施及预后。方法 回顾性分析1998-2005年14例意外胆囊癌临床资料，对本组与张氏再手术组随访结果进行分析。结果 术后无一例再手术。术后Nevin分期：Ⅱ期6例，Ⅲ期5例，Ⅳ期3例。标本中取到胆囊颈部淋巴结3例，阳性2例。本组生存期低于张氏再手术组(Plt;0.05)。结论 有胆囊癌高危因素者应及时手术，术中剖检胆囊，疑癌变快速送病检是防止意外胆囊癌的主要措施。首次手术切除范围小，有可能未取到阳性淋巴结，从而降低胆囊癌Nevin分期，故NevinⅡ期也应开腹再行区域淋巴结清扫术；再手术者生存期延长。 【关键词】 胆囊肿瘤 意外胆囊癌 肿瘤根治术 预后 【Abstract】 Objective To explore causes, preventive measures and prognosis for missed diagnosis of accidental gallbladder carcinoma (AGC). Methods A retrospective analysis was made on data of 14 cases with AGC admitted into our hospital from 1998 to 2005. The followup results of the study and operation group of Zhang were analyzed. Results The ratio of male to female was 1∶1.8 in 14 cases with AGC, of whom 92.9% of cases were over 50 years old and 85.7% associated with gallbladder stone, with no reoperation. Postoperative Nevin staging showed six cases at stage Ⅱ, five at stage Ⅲ and three at stage Ⅳ. Lymph nodes of gallbladder collum was harvested from specimen in three cases, with positive expression in two cases. Median survival time of the study was shorter than that of operation group of Zhang (12.08±1.619 vs 25.72±3.899, Plt;0.05). Conclusions For cases with high risk factors for GC, cholecystectomy should be done in time. Routine examinations of resected gallbladder tissues during operation and suspicious specimen are main preventive measures for reducing missed diagnosis. Reexploration and radical resection should be performed on AGC of Nevin stage Ⅱ, because scope of dissection is insufficient at first operation, which can lead to descend staging of AGC. Further radical resection of AGC can obtain longer survival time. 【Key words】 Gallbladder carcinoma; Accidental gallbladder carcinoma; Radical resection; Prognosis 胆囊癌是常见的胆道恶性肿瘤，早期诊断困难，手术切除低，5年生存率不足5%。若早期行根治术，则生存率明显提高。但往往是在胆囊良性疾病手术后病理检查意外发现，即所谓的意外胆囊癌(accidental gallbladder carcinoma，AGC)。因未能得到规范的胆囊癌根治术，导致预后较差。近期上海市胆囊癌流行病学调查显示意外胆囊癌占同期胆囊癌的20%［1］。目前，对意外胆囊癌的诊治仍不容乐观。笔者结合我院1998-