一例右上腹疼痛伴胆囊包块病例.ppt

基于TNM分期的手术方式 Tis期或T1a期胆囊癌,行腹腔镜胆囊切除术即可达R0切除;T1b期或T2期胆囊癌,腹腔镜手术仅作为探索性研究,且仅限于具备腹腔镜技术的专业医疗中心进行(推荐等级C级,证据等级Ⅳ级)?T2期胆囊癌,建议行开腹手术;对术前怀疑有远处转移者可行诊断性腹腔镜探查,以避免不必要的开腹手术?(推荐等级C级,证据等级Ⅳ级) 胆囊癌处理流程（胆囊癌诊断和治疗指南2015版） 肿瘤标记物未查 * 胆囊炎诊断标准：Acute cholecystitis should be suspected in a patient presenting with right upper quadrant or epigastric pain, fever, and a leukocytosis. A positive Murphys sign supports the diagnosis [18]. However, history, physical examination, and laboratory test findings are not sufficient to establish the diagnosis. Confirmation of the diagnosis requires demonstration of gallbladder wall thickeni