Vitetta L, Sali A, Little P, Mrazek L
Graduate School of Medicine, Swinburne University, Hawthorn, Victoria, Australia.
Aust N Z J Surg. 2000 Sep;70(9):667-73. doi: 10.1046/j.1440-1622.2000.01926.x.
The present study reviewed the occurrence of gall bladder carcinoma in patients who underwent a cholecystectomy for gallstone disease.
A retrospective study of demographical and clinical information for patients who underwent a cholecystectomy and operative cholangiogram for gallstones predominantly in three major hospitals located in the northern area of Melbourne was carried out.
Gall bladder carcinomas were observed in 14 patients (3.2%; 95% confidence interval (CI): 1.8-5.3%) consisting of 11 women and three men of median age 78.5 years (interquartile range: 77-81) from a series of 439 patients with a male-to-female ratio of 1-2. The results of the present study show that primary carcinoma of the gall bladder in this descriptive retrospective cohort was always associated with single or multiple cholesterol gallstones that were impacting on the gall bladder wall. Cholesterol 'solitaire' gallstones were ovoid in shape with diameters > 3 cm along their longest axis, whereas multiple cholesterol gallstones varied in size and number from two or three large stones (1-2 cm), to numerous smaller stones (variable size to 0.5 cm). No patient with gall bladder carcinoma had either brown or black pigment gallstones.
It is postulated that gall bladder carcinoma may be intimately associated with large or numerous cholesterol gallstones that in the first instance may interfere with the mechanical functioning of the gall bladder. The size as well as the number of gallstones present in the gall bladder may contribute significantly to the promotion of a gallstone filling defect of the gall bladder that may cause chronic mechanical damage to the gall bladder mucosa. The present report supports the hypothesis that gall bladder carcinoma is an age-dependent malignancy, present mostly in women, that may be intimately associated with long-standing benign gallstone disease of the gall bladder.
本研究回顾了因胆结石疾病接受胆囊切除术患者中胆囊癌的发生情况。
对主要在墨尔本北部地区三家大型医院接受胆囊切除术及术中胆管造影的胆结石患者的人口统计学和临床信息进行了回顾性研究。
在439例患者中观察到14例胆囊癌（3.2%；95%置信区间(CI)：1.8 - 5.3%），其中11例女性，3例男性，中位年龄78.5岁（四分位间距：77 - 81），男女比例为1:2。本研究结果表明，在这个描述性回顾性队列中，胆囊原发性癌总是与单个或多个压迫胆囊壁的胆固醇结石相关。胆固醇“孤立”结石呈卵形，最长轴直径>3 cm，而多个胆固醇结石大小和数量各异，从两三个大结石（1 - 2 cm）到许多较小结石（大小不一至0.5 cm）。没有胆囊癌患者有棕色或黑色色素结石。
据推测，胆囊癌可能与大的或众多的胆固醇结石密切相关，这些结石首先可能干扰胆囊的机械功能。胆囊中存在的结石大小和数量可能对促进胆囊结石充盈缺损有显著作用，这可能导致胆囊黏膜的慢性机械损伤。本报告支持以下假设：胆囊癌是一种与年龄相关的恶性肿瘤，主要见于女性，可能与胆囊长期存在的良性结石病密切相关。
