Yamamoto M, Onoyama H, Ajiki T, Yamada I, Fujita T, Saitoh Y
First Department of Surgery, Kobe University School of Medicine, Kobe City, Japan.
Hepatogastroenterology. 1999 May-Jun;46(27):1552-6.
We evaluated the surgical results for carcinoma of the gallbladder. Between 1971 and 1995 we treated 258 patients, 74 of whom were treated with simple cholecystectomy, 71 with extended cholecystectomy, and 24 with more extended operations. The tumors were classified according to the stage proposed by the Japanese Society of Biliary Surgery. For m and pm carcinoma simple cholecystectomy may have an excellent result. However, it is difficult to know cancer depth exactly before or during operation, especially when combined with inflammation due to gallstones. In Stage I disease, extended cholecystectomy had an excellent result. So extended cholecystectomy is needed even in the early stage of the disease. Second operation is needed in inapparent carcinoma of the gallbladder if the tumor is more than pm or the margin is positive. More extended operations may be needed in advanced stages for curative resection. Extended hepatic lobectomy combined with pancreaticoduodenectomy should be indicated only if the patients are in good condition because of its high postoperative mortality and morbidity without a significant improvement in survival.
我们评估了胆囊癌的手术治疗结果。1971年至1995年间，我们共治疗了258例患者，其中74例行单纯胆囊切除术，71例行扩大胆囊切除术，24例行更广泛的手术。肿瘤根据日本胆道外科学会提出的分期进行分类。对于m期和pm期癌，单纯胆囊切除术可能会有很好的效果。然而，在手术前或手术中很难准确了解癌的深度，尤其是当合并胆结石引起的炎症时。在I期疾病中，扩大胆囊切除术效果良好。因此，即使在疾病早期也需要行扩大胆囊切除术。如果胆囊隐匿性癌肿瘤超过pm期或切缘阳性，则需要二次手术。在晚期可能需要更广泛的手术以进行根治性切除。仅当患者身体状况良好时才应进行扩大肝叶切除术联合胰十二指肠切除术，因为其术后死亡率和发病率高，且生存率无显著改善。
