Clinical analysis of 36 cases of primary gallbladder cancer
He Xiaojun, Zhang Hongyi, Zhang Hongyi, Liu Xiaopeng, Zhang Xidong, Feng Zhiqiang
[Abstract] Objective To explore the effective way of gallbladder cancer diagnosis and treatment. Methods The clinical data of 36 cases of gallbladder cancer admitted to our hospital from 1986 to 2001 were retrospectively analyzed.
The clinical data of 36 patients with gallbladder cancer admitted to our hospital from 1986 to 2001 were retrospectively analyzed. The preoperative diagnosis rate was 74.3%, and 64% of gallbladder cancer cases were combined with gallbladder stones.
B ultrasound and CT were the main diagnostic tools for gallbladder cancer. The misdiagnosis rate was 17%. The surgical resection rate was 55.6 %. 1-year survival rate was 36 %, 5-year survival rate was 10 % in the Department of Hepatobiliary Surgery, Air Force General Hospital, He Xiaojun.
The rate was 10 %. Conclusion Radical surgery is preferred for stages I, II and III gallbladder cancer, and comprehensive treatment is adopted for stages IV and V. Early diagnosis and radical
early diagnosis and radical surgery is an effective way to improve the survival time of gallbladder cancer patients. For patients with high-risk gallbladder stones, cholecystectomy should be actively performed. Misdiagnosis
The reason for misdiagnosis is the lack of awareness of gallbladder cancer.
[Keywords] Gallbladder tumor; Surgical procedure
[I.C.C.] R735. 8 [I.D.] A [Article ID] 100526483 (2003) 0220083202
Cl inical analysis of primarily gallbladder carcinoma in 36 cases HE Xiaojun ,
ZHA N G Hongyi , ZHA N G Hongyi , et al . Department of Hepatobiliary S urgery , Gen2
eral of The A i r Force Beijing Hospital , Beijing 100036 ,China
[ Abstract] Objective To improve the diagnosis and therapeutic efficacy of primary gallblad2
Method A retrospective clinical analysis was made in 36 cases of gallbladder carcinoma
A retrospective clinical analysis was made in 36 cases of gallbladder carcinoma treated in our hospital from 1986 to 2001.
Ultrasonography and CT were the main method of diagnosis.
Ultrasonography and CT were the main method of diagnosis of gallbladder carcinoma. 26 cases underwent surgical treat2 ment with a resection rate of 55%.
The patients were treated with a resection rate of 55.6 %. Postoperative 1 and 5 years survival rate of resection were 36 % and
Conclusions Radical resection is the mainstay for stage Ⅰ, Ⅱ, Ⅲ gallbladder carcinoma ,and
Radical resection is the mainstay for stage Ⅰ, Ⅱ, Ⅲ gallbladder carcinoma ,and comprehensire treatment is fit for stage Ⅳ, Ⅴ. Early diagnosis and radical resection are the efficient
Early diagnosis and radical resection are the efficient methods for long – term survival of the patients with gallbladder carcinoma.
Cholecystectomy on the time is necessary to the high – risk gallstone.
[ Key words] Gallbladder neoplasm; Surgical operation
Author Affiliation:100036 Beijing, Air Force General Hospital, Department of Hepatobiliary Surgery
Gallbladder cancer has become a common malignant tumor of the biliary tract.
The 5-year survival rate is less than 5% because of the difficulty of early diagnosis and low surgical resection rate[1] . In recent years
primary gallbladder cancer has been improved in diagnosis and treatment, but the treatment effect
However, the treatment results are still poor. In this paper, we summarize the clinical data of 36 cases of gallbladder cancer in our hospital from 1986 to 2001.
The clinical data of 36 cases of gallbladder cancer in our hospital from 1986 to 2001 are summarized. The results are reported as follows.
Clinical data
I. General information
In this group, there were 36 cases, 19 males and 17 females, aged 35-84 years.
The average age was 61 years. Among them, 28 cases were over 50 years old, accounting for 77.8 %;
The size of the stones ranged from 0.6 to 3.5 cm, of which >2.0 cm was the size of the gallbladder stones.
The size of stones ranged from 0.6 to 3.5 cm, among which 13 cases were >2.0 cm, 3 cases were <1.0 cm, and 18 cases had embedded stones in the neck.
18 cases, 8 cases of gallbladder atrophy, 12 cases of combined masses; 3 cases of gallbladder polyps with malignant
There were 3 cases of malignant transformation of gallbladder polyps, accounting for 8.3%.
The clinical manifestations of the cases in this group were not specific, and the duration of the disease ranged from 5 h to 10 years.
The duration of the disease ranged from 5 h to 10 years, and the history of gallbladder stones ranged from 6 to 30 years, with an average of more than 10 years. The most common symptoms were
The most common symptoms were abdominal pain in 30 cases (83%), jaundice in 7 cases (20%), and right upper abdominal mass in 2 cases (6%).
The most common symptoms were abdominal pain in 30 cases (83%), jaundice in 7 cases (20%), right upper abdominal mass in 2 cases (6%) and physical examination in 2 cases (6%).
Imaging examination
In this group, 35 cases of abdominal B-ultrasound were performed, and one case died on the day of admission.
The diagnosis of gallbladder cancer was confirmed at autopsy, with a diagnostic compliance rate of 74.3% (26/ 35). The rate of diagnosis was 74.3% (26/ 35).
Among the 9 cases that could not be diagnosed, 4 cases were diagnosed with gallbladder stones and cholecystitis, and 2 cases were diagnosed with gallbladder polyps.
Only polyps > 1.0 cm in diameter were indicated, one case was acute cholecystitis, and two cases were due to tumor.
One case was diagnosed as acute cholecystitis, and two cases were diagnosed as bile duct cancer due to tumor metastasis.
One of the 17 CT cases was diagnosed as cholangiocarcinoma and one was diagnosed as polyp, with a compliance rate of 88.2 %.
ERCP examination showed cauliflower-like mass in the gallbladder in 2 out of 6 cases, and the gallbladder was not visualized with bile ducts in 2 cases.
In two cases, the gallbladder was not visualized and the bile duct was compressed, and in two cases, the bile duct was interrupted.
Surgical methods
In this group, 26 cases were treated surgically, including 6 cases of cholecystectomy, 6 cases of cholecystectomy + liver wedge resection + lymph nodes.
In this group, 26 cases were treated surgically, 6 were cholecystectomies, 14 were cholecystectomies + liver wedge resection + lymph node dissection, 3 were bile-intestinal anastomoses or T-tube drainage, and 3 were open exploration.
3 cases, 2 cases with open bile duct support drainage, and 1 case with percutaneous hepatic bile duct
One case was drained by percutaneous hepatic bile duct. The tumor resection rate was 55.6 % (20/ 36). Postoperative pathology report
Journal of Clinical Surgery, March 2003, Vol. 11, No. 2 J Clin Surg, March 2003, Vol. 11, No. 2 ・83 ・.
The results showed that 13 cases of highly differentiated adenocarcinoma, 3 cases of moderately differentiated adenocarcinoma, 2 cases of poorly differentiated adenocarcinoma, and 2 cases of tubular adenocarcinoma were reported.
One case of small cell adenocarcinoma.
IV. Results
According to Nevin’s staging criteria: 2 cases in stage I, 1 case in stage II,
5 cases of stage III, 8 cases of stage IV, and 20 cases of stage V. Among the surgical cases, 13 cases directly invaded the liver.
There were 13 cases with direct liver invasion, 10 cases with liver metastasis, and 4 cases with abdominal metastasis,
Seven cases had intra-biliary metastases. The follow-up rate of 28 cases was 36% at 1 year and 10% at 5 years.
The survival rate was 10 %. The median survival time of stage V was 1-9 months, and the median survival
The median survival time was 4 months.
Discussion
I. Early diagnosis
The clinical manifestations of gallbladder cancer are not specific in early stage, and most of them are late when detected.
The clinical manifestations of gallbladder cancer are not specific at the early stage, and most of them are late when detected. Among various imaging examinations, the diagnosis rate of B-ultrasound is 83.4% [2]. In our group
In our group, the preoperative B-ultrasound diagnosis rate was 74.3 %, which is the first choice for the diagnosis of gallbladder cancer.
However, the misdiagnosis rate of early gallbladder cancer by ultrasound is high, especially when the wall of gallbladder is not thick.
However, the misdiagnosis rate of early gallbladder cancer is high, especially when the gallbladder wall is not thick, it is often diagnosed as gallbladder stones or benign polyps.
The reason for this is that the diagnosis of gallbladder stones or polyps is only satisfied with the diagnosis of gallbladder stones or polyps.
The reason for this is that the diagnosis of gallbladder stones or polyps is not satisfied with the thickness of the gallbladder wall, the presence of liver infiltration and surrounding lymph node enlargement.
In acute inflammation, the gallbladder wall is edematous and the contents of the gallbladder are not clearly visible. In this case
CT examination has a higher diagnosis rate than B ultrasound examination, and can better show the anatomical relationship between the gallbladder
In this case, the diagnosis rate of CT examination is higher than that of B ultrasound, and it can better show the anatomical relationship between the gallbladder and the adjacent organs, the degree of tumor infiltration and metastasis, and provide a basis for the selection of surgical methods.
ERCP examination is not clinically significant and is only useful for understanding the gallbladder.
The ERCP examination is not clinically significant, but is only useful for understanding the characteristics of occupying lesions in the gallbladder. In our group, among the 26 cases diagnosed by B
In the 26 cases diagnosed by ultrasound, all of them showed irregular thickening of the gallbladder wall or interruption of the gallbladder wall.
In 8 cases, the gallbladder stones were combined with intracapsular gallbladder lesions, while the malignant gallbladder polyps were larger than the diameter.
We believe that when B-ultrasound, CT, cholangiography and other examinations are performed, the gallbladder wall will be thickened.
We believe that gallbladder cancer should be considered when the following signs are detected by ultrasound, CT, cholangiography, etc:
(1) a limited or overall thickening of the gallbladder wall > 0.5 cm in an irregular shape; (2) a polyp with a diameter of 1.0 cm or more.
(2) polyp-like lesions with a diameter of 1.0 cm or more and a wide base; (3) intracapsular gallbladder
(3) intracorporeal lesions combined with gallbladder stones; (4) “porcelain-like gallbladder”.
Surgical methods
Surgery is still the first choice in the treatment of gallbladder cancer, but only 20-30% of gallbladder cancers can be treated with surgery.
However, only 20-30% of gallbladder cancers can be radically resected [1 ].
Recently, some scholars have suggested that simple cholecystectomy is not enough for stage I and II gallbladder cancer.
Some scholars have recently suggested that simple cholecystectomy is not enough for stage I and II gallbladder cancer and advocate radical resection, i.e. cholecystectomy +
The radical resection, i.e., cholecystectomy + wedge resection of liver tissue in the gallbladder bed + lymph node dissection of hepatoduodenal ligament, is advocated to improve the long-term
In order to improve the long-term survival rate of patients [3,4]. The surgical approach for stage IV and V gallbladder cancer is
In our group of 20 stage V cases, the surgical approach was more controversial. In our group, only 3 out of 20 stage V cases underwent
tumor resection, with a resection rate of 15%, and their survival time was not significantly longer than those without surgical resection.
The survival time was not significantly prolonged compared with those without surgical resection. In contrast, two cases of gallbladder polyps with cancerous lesions underwent simple gallbladder
In the two cases of gallbladder polyp carcinoma with simple cholecystectomy, the survival was more than 5 years. We suggest that simple cholecystectomy for polyps with cancerous lesions is sufficient.
for stage II and III gallbladder cancer, and radical surgery for stage IV and V gallbladder cancer is recommended.
For stage II and III gallbladder cancer, radical surgery is recommended; for stage IV and V, palliative surgery or simple drainage should be performed, and it is not necessary to force
radical resection of the tumor, in order to improve patients’ quality of life and prolong their survival.
The aim is to improve the quality of life and prolong the survival time of patients.
Gallbladder stones and gallbladder cancer
A lot of epidemiological data and experimental studies have confirmed that gallbladder stones can
gallbladder stones can induce gallbladder cancer [5]. The incidence of gallbladder cancer in patients with gallbladder stones has been reported to be
The incidence of gallbladder cancer in patients with gallbladder stones has been reported to be 13.7 times higher than that in patients without stones[6] . In our group, 23 cases of gallbladder stones combined with gallbladder cancer
In our group, 23 cases of gallbladder stones were combined with gallbladder cancer, accounting for 1.5% of gallbladder stone cases in the same period. Among them
The incidence of gallbladder cancer in patients with stones ≥ 2.0 cm in diameter was 4.3 times higher than that in patients with stones < 1.0 cm.
The incidence of gallbladder cancer was 4.3 times higher in stones ≥2.0 cm than in stones <1.0 cm, especially in stones embedded in the neck. The incidence of gallbladder cancer was 4.3 times higher in those with stones ≥ 2.0 cm in diameter than in those with stones < 1.0 cm in diameter, especially in stones lodged in the neck.
The incidence of gallbladder cancer with masses or acute calculous cholecystitis as a symptom is often advanced, and the surgical resection rate is low.
The rate of surgical resection is low. In our case, a 77-year-old female patient with an embedded gallbladder neck stone resulted in a low surgical resection rate.
In our case, a 77-year-old female patient underwent cholecystostomy for gallbladder perforation due to stone impaction in the neck of gallbladder.
The patient’s family was reluctant to operate again, and liver metastasis occurred 3 months later.
Therefore, intraoperative cryopreservation is required for patients with high-risk gallstones.
The diagnosis of gallbladder cancer is immediate radical surgery. We consider the following as high-risk factors for gallbladder cancer
(1) recurrent cholecystitis and gallbladder stones;
(2) Age ≥ 60 years and history of gallbladder stones for more than 10 years; (3) Gallbladder
stones > 2.0 cm in diameter or with gallbladder atrophy; (4) embedded gallbladder neck
(5) gallbladder stones combined with gallbladder wall thickening; (6) Mirizzi syndrome
(6) Mirizzi syndrome; (7) post-cholecystostomy.
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[He Xiaojun (1967 – ), Male, Attending Physician.
(Received: 2002203217)