急性化脓性结石性胆囊炎与胆囊腺癌；一种有趣的关联。

Charalampopoulos A, Lazaris A, Misiakos E, Liakakos S, Macheras A, Peschos D, Batistatou A, Fotiadis K, Charalabopoulos K

Third Department of Surgery, Athens University Medical School, Athens, Greece.

Acta Gastroenterol Belg. 2007 Jul-Sep;70(3):267-70.

BACKGROUND AND STUDY AIMS

Primary carcinoma of the gallbladder may present as acute lithiasic cholecystitis that leads to severe septic complications. The correlation between severe sepsis of the gallbladder and primary carcinoma is unclear. The goal of the present study is to examine the relation between severe septic complications of lithiasic cholecystitis and primary carcinoma of the gallbladder.

PATIENTS AND METHODS

A group of 72 patients (22 males, 50 females, age range: 45-99, mean age: 68.6 years), with severe septic cholelithiasic cholecystitis was treated with emergency surgery after failure of conservative treatment, and patients found with primary carcinoma of the gallbladder were registered. The resectability and operability of the tumor were studied, as well as tumor staging and overall patient survival.

RESULTS

During urgent surgery for severe septic lithiasic cholecystitis, 12 patients (12/72, 16.6%) were found with gallbladder carcinoma. Patients with septic acute lithiasic cholecystitis and carcinoma had a higher mean age compared to those without carcinoma (74.8 vs. 67.4 yrs). Eleven of 12 (91.6%) carcinomas were inoperable, despite resectability of 8 out of 12 (66.6%), and overall patient survival was limited to a few months after surgery.

CONCLUSIONS

Severe septic complications in elderly patients with a long-standing history of gallbladder stones may co-exist with primary carcinoma of the gallbladder. The percentage of a gallbladder carcinoma detected in septic patients reaches up to 16.6%. Even if these patients have a poor general health, surgical intervention is a solution when they appear with severe septic clinical symptoms caused by gallstones or carcinoma, in order to avoid lethal sepsis. The possibility of a carcinoma hidden in the gallbladder must be in mind during surgery. Imaging studies before surgery may detect the carcinoma; in most cases carcinomas are inoperable, although colecystectomy may be performed during surgery.

背景与研究目的

胆囊原发性癌可能表现为急性结石性胆囊炎，并导致严重的脓毒症并发症。胆囊严重脓毒症与原发性癌之间的相关性尚不清楚。本研究的目的是探讨结石性胆囊炎严重脓毒症并发症与胆囊原发性癌之间的关系。

患者与方法

一组72例患者（男22例，女50例，年龄范围：45 - 99岁，平均年龄：68.6岁），患有严重脓毒症性结石性胆囊炎，在保守治疗失败后接受了急诊手术，并对发现患有胆囊原发性癌的患者进行了登记。研究了肿瘤的可切除性和可操作性，以及肿瘤分期和患者总体生存率。

结果

在严重脓毒症性结石性胆囊炎的急诊手术中，发现12例患者（12/72，16.6%）患有胆囊癌。与无癌患者相比，患有脓毒症性急性结石性胆囊炎和癌的患者平均年龄更高（74.8岁对67.4岁）。12例中的11例（91.6%）癌无法手术，尽管12例中有8例（66.6%）可切除，且患者总体生存仅限于术后几个月。

结论

有长期胆囊结石病史的老年患者严重脓毒症并发症可能与胆囊原发性癌并存。脓毒症患者中检测出胆囊癌的比例高达16.6%。即使这些患者总体健康状况较差，当他们出现由胆结石或癌引起的严重脓毒症临床症状时，手术干预仍是一种解决办法，以避免致命的脓毒症。手术期间必须考虑胆囊隐匿癌的可能性。术前影像学检查可能检测出癌；在大多数情况下，癌无法手术，尽管手术期间可能进行胆囊切除术。