Iida F, Kajikawa S, Horigome N
Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
J Am Coll Surg. 1995 Jan;180(1):72-6.
Hepatic invasion is an important factor in the selection of an operative procedure for patients with carcinoma of the gallbladder. Imaging modalities to detect the hepatic invasion were evaluated for accuracy, and postoperative patient outcome was analyzed.
Thirty-six patients who were treated for carcinoma of the gallbladder at our institution between 1984 and 1993 were studied. The imaging results of ultrasonography (US), computed tomography, and angiography were compared with histologic findings regarding intrahepatic invasion of the carcinoma.
Histologic examination of the operative specimens removed from 21 patients revealed that the detection of hepatic invasion with preoperative US was superior to that with the other two modalities. The preoperative US showed a diagnostic value that was almost the same as that of the intraoperative US. The postoperative patient outcome was not satisfactory, although extended radical operation was performed using image guidance in the 21 patients. The patients died as a result of nodal recurrence rather than hepatic recurrence.
Preoperative US should be performed initially for detecting hepatic invasion from carcinoma of the gallbladder and can be substituted for intraoperative US. Considering the operative treatment for patients with carcinoma of the gallbladder, lymph node dissection is as important as the extent of hepatectomy.
肝侵犯是选择胆囊癌患者手术方式的一个重要因素。对检测肝侵犯的影像学检查方法的准确性进行了评估，并分析了术后患者的预后情况。
对1984年至1993年间在我院接受胆囊癌治疗的36例患者进行了研究。将超声检查（US）、计算机断层扫描和血管造影的影像学结果与关于癌灶肝内侵犯的组织学检查结果进行了比较。
对21例患者手术切除标本的组织学检查显示，术前超声检测肝侵犯的能力优于其他两种检查方法。术前超声的诊断价值与术中超声几乎相同。尽管对这21例患者采用影像引导进行了扩大根治性手术，但术后患者的预后并不理想。患者死于淋巴结复发而非肝复发。
术前应首先进行超声检查以检测胆囊癌的肝侵犯，且可替代术中超声。考虑到胆囊癌患者的手术治疗，淋巴结清扫与肝切除范围同样重要。
