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目的 :讨论原发性胆囊癌误诊原因以提高诊断率。方法 :对近 8年 5 0例经病理证实为胆囊癌的临床表现 ,影像学特点和术中判断进行回顾分析。结果 :①临床表现 :右上腹不适 ,饱胀感为 74 % ,恶心、呕吐为 4 4 % ,消瘦为 30 % ,右上腹明显疼痛为 2 6 % ,黄疸为 2 0 %。入院诊断符合率为 4 6 % ,不符合率为 5 4 %。②所有病例均经B超检查 ,4 0例行CT检查。B超诊断符合率为 74 % ,假阴性率为 2 6 % ,CT诊断符合率为92 .5 % ,假阴性率为 7.5 %。B超联合CT检查提高诊断符合率达 94 % ,对胆囊壁不规则增厚及腔内广基的软组织肿块应警惕胆囊癌的可能。③术中对肉眼和手感发现胆囊壁不规则增厚者 ,应按常规作胆囊剖开及术中冰冻病理检查。结论 :重视腹痛、消瘦、黄疸患者的临床表现 ,对胆囊壁不规则增厚、胆囊腔内广基的软组织肿块影像学特点及术中判断胆囊壁不规则增厚、质稍硬者 ,应作常规冰冻病理检查 ,这是提高胆囊癌诊断率的重要环节。
Objective: To discuss the causes of misdiagnosis of primary gallbladder cancer to improve the diagnosis rate. Methods: The clinical manifestations, imaging features and intraoperative judgment of 50 cases of gallbladder carcinoma confirmed by pathology were retrospectively analyzed. Results: ① The clinical manifestations: right upper quadrant discomfort, fullness was 74%, nausea and vomiting was 44%, weight loss was 30%, right upper quadrant pain was 26%, jaundice 20%. The coincidence rate of admission diagnosis was 46% and the non-coincidence rate was 54%. ② All cases were B-ultrasound, 40 routine CT examination. The coincidence rate of B ultrasound diagnosis was 74%, false negative rate was 26%, CT diagnostic coincidence rate was 92.5%, false negative rate was 7.5%. B ultrasound combined with CT examination to improve the diagnostic coincidence rate of 94%, irregular thickening of the gallbladder wall and cavity wide base of soft tissue mass should be alert to the possibility of gallbladder cancer. ③ Surgery on the naked eye and feel irregular thickening of the gallbladder wall, should be routine for gallbladder dissection and intraoperative frozen pathological examination. Conclusion: The clinical manifestations of patients with abdominal pain, weight loss and jaundice are emphasized. The imaging characteristics of soft tissue mass with irregular thickening of gallbladder wall and wide base of gallbladder cavity and the irregular thickening of gallbladder wall in operation, Conventional frozen pathological examination, which is to improve the diagnosis of gallbladder cancer an important part.