Ueda Nobuhiko, Fujii Yoritaka, Miura Seiko, Fujita Jun, Kaida Daisuke, Tomita Yasuto, Ohnishi Toshio, Funaki Hiroshi, Fujita Hideto, Kinami Shinichi, Nakano Yasuharu, Kosaka Takeo
Dept. of General and Digestive Surgery, Kanazawa Medical University.
Gan To Kagaku Ryoho. 2016 Nov;43(12):1597-1599.
We report a case of a radical resection of cT3a gallbladder cancer after neoadjuvant chemotherapy(NAC). A 68-year-old man was referred to our hospital with a chief complaint of right hypochondralgia.Imaging findings were consistent with acute cholecystitis with a stone at the neck of the gallbladder, and advanced gallbladder cancer with infiltration into segments 4 and 5 from the fundus of the gallbladder, Gfb, cT3a(liver), cN1(8a), cM0, cStage III B, was diagnosed on staging laparoscopy. The patient received 3 courses of GEM plus CDDP NAC.The response to the treatment included reduction of the main tumor by 35%, diminished accumulation of FDG at the 8a lymph node, and decrease in serum CA19-9, from 163 U/mL to 75 U/mL. Cholecystectomy with the gallbladder bed and regional lymphadenectomy were performed.The histologic examination revealed extensive necrosis and degeneration of cancer cells in the infiltrating lesions, and the therapeutic effect was judged as Grade I b.The patient has now survived for 11 months without recurrence.
我们报告一例新辅助化疗（NAC）后行cT3a期胆囊癌根治性切除术的病例。一名68岁男性因右季肋部疼痛为主诉转诊至我院。影像学检查结果符合胆囊颈部结石伴急性胆囊炎，以及胆囊底部浸润至第4和第5段的进展期胆囊癌，Gfb，cT3a（肝脏），cN1（8a），cM0，c期IIIB，经分期腹腔镜检查确诊。患者接受了3个疗程的吉西他滨联合顺铂新辅助化疗。治疗反应包括主要肿瘤缩小35%，8a淋巴结处FDG摄取减少，血清CA19-9从163 U/mL降至75 U/mL。行胆囊床胆囊切除术及区域淋巴结清扫术。组织学检查显示浸润性病变中癌细胞广泛坏死和退变，治疗效果判定为I b级。该患者目前已存活11个月，无复发。
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