Department of Surgery, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, South Korea.
Department of Radiology, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, South Korea.
Int J Surg. 2017 Sep;45:1-7. doi: 10.1016/j.ijsu.2017.07.046. Epub 2017 Jul 15.
Gallbladder cancer (GBCA) is an uncommon malignancy with vague and non-specific symptoms. GBCA is sometimes diagnosed after emergency cholecystectomy for acute cholecystitis. We investigated the differential diagnosis between GBCA with acute cholecystitis.
Thirteen patients were diagnosed with GBCA after emergency cholecystectomy carried out for acute cholecystitis. A radiologist who was blinded to the final diagnoses retrospectively reviewed the computed tomography (CT) scans of the patients with GBCA and 25 patients with acute cholecystitis. We retrospectively reviewed the medical records of these patients and compared the clinical characteristics and CT findings between patients with GBCA and those with acute cholecystitis. We also investigated the prognostic factors in patients with GBCA who underwent emergency cholecystectomy.
Gallbladder (GB) stones were found more often in patients with acute cholecystitis (n = 17, 68%) than in patients with GBCA (n = 7, 53.8%) (p = 0.486). Patients with GBCA showed typical GB masses or focal enhanced wall thickening when compared to diffuse wall thickening in patients with acute cholecystitis. Some GBCA patients showed irregular mural thickening and GB enhancement. Differentiating carcinoma from acute cholecystitis might sometimes not possible, but the latter group of patients had significantly lower C-reactive protein (CRP) levels (p = 0.033) and less regional fat stranding (p = 0.047). Survival was significantly affected by aggressive tumor characteristics (lymphatic invasion [p = 0.025], depth of tumor invasion [p = 0.004]) or R0 resection (p = 0.013) rather than bile spillage (p = 0.112).
Surgeons deciding on emergency cholecystectomy for elderly patients with acute cholecystitis must suspect GBCA in patients with a low CRP level, irregular mural thickening or enhancement of GB without regional fat stranding.
胆囊癌（GBCA）是一种罕见的恶性肿瘤，其症状模糊且非特异性。GBCA 有时在因急性胆囊炎而行紧急胆囊切除术时被诊断出来。我们研究了 GBCA 与急性胆囊炎的鉴别诊断。
13 名患者因急性胆囊炎而行紧急胆囊切除术，术后被诊断为 GBCA。一位对最终诊断不知情的放射科医生回顾性地分析了这 13 名 GBCA 患者和 25 名急性胆囊炎患者的 CT 扫描图像。我们回顾性地查阅了这些患者的病历，并比较了 GBCA 患者和急性胆囊炎患者的临床特征和 CT 表现。我们还研究了接受紧急胆囊切除术的 GBCA 患者的预后因素。
急性胆囊炎患者（n=17，68%）比 GBCA 患者（n=7，53.8%）更常发现胆囊（GB）结石（p=0.486）。与急性胆囊炎患者弥漫性胆囊壁增厚相比，GBCA 患者表现为典型的胆囊肿块或局灶性增强壁增厚。一些 GBCA 患者表现为不规则的壁增厚和胆囊强化。有时可能无法将癌与急性胆囊炎区分开来，但后者组患者的 C 反应蛋白（CRP）水平明显较低（p=0.033），且区域脂肪条索征较少（p=0.047）。生存情况受到侵袭性肿瘤特征（淋巴浸润[p=0.025]、肿瘤侵犯深度[p=0.004]）或 R0 切除（p=0.013）的显著影响，而不是胆汁外溢（p=0.112）。
对于患有急性胆囊炎的老年患者，如果 CRP 水平低、GB 不规则壁增厚或增强且无区域脂肪条索征，外科医生在决定行紧急胆囊切除术时必须怀疑 GBCA。
