原发性胆囊癌术前误诊分析及预防
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牟洪超 E-mail:muhc@sina.com

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Analysis of the preoperative misdiagnosis of primary gallbladder carcinoma and its prevention
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    摘要:

    目的:分析原发性胆囊癌术前误诊原因,探索有效的预防误诊的措施。
    方法:对收治的52例原发性胆囊癌患者的临床资料进行回顾性分析,着重分析术前误诊原因。
    结果:术前明确诊断19例(36.5%)。术前误诊33例(63.5%),其中误诊为胆囊结石13例,胆囊息肉样变8例,萎缩性胆囊炎4例,肝门部胆管癌3例,肝占位病变4例,Mirizzi综合征1例。术前误诊的33例术中明确诊断29例(55.8%),另有4例术后常规病理检查才明确诊断(7.7%)。误诊的原因较多,如缺乏特异性临床表现、并发胆囊其他疾病、过分依赖影像学检查、术中对可疑病灶未做快速冷冻病理检查等。
    结论:对存在胆囊癌高危因素的可疑者应定期进行影像学检查,必要时进行有创性检查,甚至手术探查,术中进行快速冷冻切片病理检查,可做到早发现,早治疗,有助于改善胆囊癌患者预后。

    Abstract:

    ObjectiveTo analyze the causes of preoperative misdiagnosis of primary gallbladder carcinoma, and the effective measures of prevention of the misdiagnosis.
    MethodsWe retrospectively analyzed the clinical records of 52 cases with primary gallbladder carcinoma that had been treated in our hospital in 10 years,and analyzed the causes of misdiagnosis.
    ResultsNineteen cases were diagnosed preoperatively(36.5%), while 33 cases were misdiagnosed before operation(63.5%), including misdiagnsed as cholecystolithiasis in 13 cases, gallbladder polyps in 8cases, atrophic cholecystitis in 4cases, hepatic hilar cholangiocarcinoma in 3 cases, tumor of liver in 4 cases,and Mirizzi syndrome in 1 case.There were 29 cases diagnosed during operation(55.8%),and 4 cases misdiagnosed intratoperatively(7.7%). Misdiagnosis was due to several reasons:complicated with other gallbladder disease, lack of distinctive clinical features of gallbladder carcinoma, over dependence on imaging methods,and not doing fast frozen section during operation in dubious cases.
    ConclusionsIn suspected cases with high risk of gallbladder cancer,imaging studies should be performed,and, if necessary, invasive studies and even exploratory laparotomy should be done. Also,intraoperative rapid frozen section can result in early discovery and treatment,and is conducive to improvement of prognosis of gallbladder carcinoma.

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牟洪超| 周辉| 董立军| 孙茂.原发性胆囊癌术前误诊分析及预防[J].中国普通外科杂志,2009,18(8):824-827.
DOI:10.7659/j. issn.1005-6947.2009.08.015

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  • 在线发布日期: 2009-08-15