Piehler J M, Crichlow R W
Surg Gynecol Obstet. 1978 Dec;147(6):929-42.
Data from 6,222 patients with primary carcinoma of the gallbladder reported upon in the past 15 years have been analyzed. The disease occurs predominately in elderly females who often present with extremes of clinical symptoms, suggesting, on one hand, benign calculous disease or, on the other, advanced incurable malignant disease. Laboratory and x-ray data tend to confirm the clinical diagnosis of incurable disease, but do not aid in determining those patients with early, potentially curable lesions. The biologic nature of the tumor makes most carcinomas unsuspected findings at the time of operation and limits those patients presenting with resectable disease to about 25 per cent. The over-all five year survival of patients with carcinoma of the gallbladder is only 4.1 per cent. Furthermore, virtually the only survivors are those with lesions resected early that were not apparent to the operating surgeon and of the papillary cell type without significant invasion of the wall of the gallbladder. If the tumor is recognized and believed to be resected, survival is only 2.9 per cent, with failures caused by locally recurrent tumor. Despite the obvious failure of management of carcinoma of the gallbladder, therapeutic advantage has not been taken of the tumor's propensity to remain locally invasive by extending the scope of the traditional cholecystectomy to include en bloc hepatic wedge resection and regional lymphadenectomy in treating patients with recognized malignant tumors. Reoperation for delayed hepatic resection and lymph node dissection should be considered in selected patients with carcinoma unsuspected at operation but noted in the resected specimen. Selected application of this approach might offer the chance of cure to a small, but definite, group of patients who are currently being undertreated.
对过去15年报道的6222例原发性胆囊癌患者的数据进行了分析。该疾病主要发生在老年女性中，她们常常表现出极为极端的临床症状，一方面提示为良性结石病，另一方面提示为晚期无法治愈的恶性疾病。实验室和X线检查数据倾向于证实无法治愈疾病的临床诊断，但无助于确定那些患有早期、可能治愈性病变的患者。肿瘤的生物学特性使得大多数癌症在手术时未被怀疑，并且将那些呈现可切除疾病的患者比例限制在约25%。胆囊癌患者的总体五年生存率仅为4.1%。此外，实际上唯一的幸存者是那些早期切除的病变在手术时未被外科医生发现，且为乳头状细胞类型且未明显侵犯胆囊壁的患者。如果肿瘤被识别并认为已被切除，生存率仅为2.9%，失败原因是局部复发性肿瘤。尽管胆囊癌的治疗明显失败，但尚未利用肿瘤倾向于局部浸润这一特点，通过扩大传统胆囊切除术的范围，将肝楔形整块切除和区域淋巴结清扫纳入对已识别恶性肿瘤患者的治疗中。对于手术时未被怀疑但在切除标本中发现的胆囊癌患者，应考虑对选定患者进行延迟肝切除和淋巴结清扫的再次手术。这种方法的选择性应用可能为一小部分但确定的目前治疗不足的患者提供治愈的机会。
