意外早期胆囊癌的手术治疗与预后分析

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1、作者：陈飞1,李炜2,韩峰2作者单位：（1.通州市中医院普外科，江苏南通226300:2.上海中医药大学附属普陀医院普外科，上海200062）【摘要】目的探讨意外发现的早期胆囊癌的治疗方法与预后。方法回顾性总结1995年7月至2005年7力我院收治的24例意外早期胆囊癌临床病理资料，对其治疗方法及影响预后的因素进行分析。结果24例术中快速冰冻切片或术后病理切片证实为早期胆囊癌(NevinI~II期)。7例于术中施行了标准的根治术，10例术后确诊再行根治，7例行单纯胆囊切除术。多因素分析表明，组织学分级、Ne

2、vin分期及手术方式是影响预后的独立因素;再次行根治手术组生存率与即刻行根治手术组比较无统计学差异，单纯胆囊切除术组与胆囊癌根治术组患者的生存率差异有统计学意义。结论早期胆囊癌术前诊断困难，术中对可疑者做快速冰冻切片检查有助于发现早期胆囊癌;一旦确诊即予施行根治术，术后病理明确者亦应再行根治手术。【关键词】意外早期胆囊癌;手术治疗;预后SurgicaltreatmentandprognosisofearlystageunexpectedgallbladdercarcinomaCHENFei*,LIWei,H

3、ANFeng.*DepartmentofGeneralSurgery,TraditionalChineseMedicalHospitalofTongzhou,Nantong226300AbstractObjectiveToexplorethesurgicaltreatmentandprognosisofearlystageunexpectedgallbladdercarcinoma.MethodsTheclinicalandpathologicaldataof24patientswithearlystage

4、gallbladdercarcinomatreatedinourhospitalfromJuly1995toJuly2005wereretrospectivelysummarized,inwhichdifferenttreatmentandfactorsaffectingprognosiswereanalyzed・ResultsAllthe24caseswereconfirmedasearlystagegallbladdercarcinoma(NevinI~IIstage)byfrozensectionex

5、aminationduringoperationorpathologicalexaminationafteroperation.Sevencasesreceivedradicalresectionimmediately^10underwentsecondradicalresectionwhenthediagnosiswasconfirmedtand7casesonlyreceivedsimplecholecystectomy.Multivariateanalysisshowedthathistologica

6、ldifferentiationtNevinstageandsurgicalmethodsweretheindependentfactorsforprognosisofearlystageunexpectedgallbladdercarcinoma.Therewasnosignificantdifferenceinthesurxdvalratebetweenpatientswhoreceivedradicalresectionimmediatelyandthosewhoreceivedradicalrese

7、ctioninthesecondoperation;butsignificantdifferencewasobservedbetweenpatientswhoreceivedradicalresectionandthosewhonot.ConclusionItisdifficulttodiagnosetheearlystagegallbladdercarcinomabeforeoperation.Frozensectionexaminationshouldbeperformedforthesuspected

8、lesions,whichcontributesalottotheearlydiagnosisofunexpectedgallbladdercarcinoma.Radicalresectionshouldbeperformedoncethediagnosisisconfirmedbypathologicalevidence,wheneverduringoperationorafteroperation.Keywo