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目的 探讨误诊为胆囊良性疾病的胆囊癌二次手术方式以及对预后的影响。方法对于1995年6月~2002年12月因误诊为胆囊良性疾病而切除胆囊,因术后病理证实为胆囊癌而二次行胆囊癌扩大根治术的41例患者进行回顾性分析。41例患者中,男12例,女29例,平均年龄51岁,均因胆囊炎(41例)或并发胆囊结石(32例)、胆囊息肉或腺瘤(9例)在第一次手术时行单纯胆囊切除。术后病理:胆囊腺癌32例,鳞癌6例,鳞腺癌3例;NevinⅠ期6例,Ⅱ期16例,Ⅲ期17例,Ⅳ期2例,Ⅴ期0例。二次手术距一次手术间隔时间为6~30d。二次手术均行以改良的Glenn根治性胆囊癌切除术为标准的胆囊癌根治术式。结果 二次手术时发现14例患者有淋巴结转移, 14例患者有胆囊床转移, 6例患者有胆管转移, 2例患者有胰腺转移;NevinⅣ期14例,Ⅴ期9例,无Ⅰ、Ⅱ、Ⅲ期者。二次手术后1年后存活率100% ( 41例), 3年存活率53. 8% ( 22例), 5年存活率17. 5% ( 7例)。结论 扩大根治术是治疗误诊为胆囊良性疾病的胆囊癌的重要方法之一。
Objective To investigate the secondary operation of gallbladder carcinoma misdiagnosed as gallbladder benign disease and the impact on prognosis. Methods From June 1995 to December 2002, 41 patients with gallbladder cancer who had been misdiagnosed as benign disease of gallbladder and 41 patients with secondary gallbladder carcinoma underwent radical gastrectomy due to pathologically confirmed gallbladder cancer were analyzed retrospectively. Among the 41 patients, there were 12 males and 29 females, with a mean age of 51 years. All of them had cholecystitis (41 cases) or complicated gallstones (32 cases), gallbladder polyps or adenomas (9 cases) at the time of the first operation Simple cholecystectomy. Postoperative pathology: 32 cases of gallbladder adenocarcinoma, 6 cases of squamous cell carcinoma and 3 cases of squamous carcinoma; 6 cases of Nevin Ⅰ, 16 cases of stage Ⅱ, 17 cases of stage Ⅲ, 2 cases of stage Ⅳ and 0 cases of stage Ⅴ. Secondary surgery from an operation interval of 6 ~ 30d. Secondary surgery were performed with modified Glenn radical cholecystectomy as a standard radical gastrectomy. Results There were 14 cases with lymph node metastasis in secondary surgery, 14 cases with gallbladder bed metastasis, 6 cases with bile duct metastasis and 2 cases with pancreas metastasis. There were 14 cases in Nevin Ⅳ stage and 9 cases in stage Ⅴ without Ⅰ, Ⅱ, Ⅲ period. Survival rate was 100% (41 cases) one year after secondary surgery, 3-year survival rate was 53.8% (22 cases), and 5-year survival rate was 17.5% (7 cases). Conclusion Extended radical mastectomy is one of the important methods for the treatment of gallbladder cancer misdiagnosed as gallbladder benign disease.