胆囊原发性癌合并急性胆囊炎。

Concurrent primary carcinoma of the gallbladder and acute cholecystitis.

作者信息

Chao T C, Jeng L B, Jan Y Y, Hwang T L, Wang C S, Chen M F

机构信息

Department of Surgery, Chang Gung Medical College, and Chang Gung Memorial Hospital, Taipei, Taiwan.

出版信息

Hepatogastroenterology. 1998 Jul-Aug;45(22):921-6.

PMID:9755981

Abstract

BACKGROUND/AIMS: Primary carcinoma of the gallbladder is rare and associated with a late diagnosis and poor prognosis. Concurrent acute cholecystitis frequently obscures the presence of carcinoma. The information regarding gallbladder carcinoma with acute cholecystitis is limited. In order to better understand the presentation of gallbladder carcinoma with acute cholecystitis, we retrospectively reviewed the data of patients with primary carcinoma of the gallbladder.

METHODOLOGY

The data of 86 patients with primary carcinoma of the gallbladder treated between 1979 and 1994 were compiled and reviewed. The patients were divided into 2 groups: Group 1 (with acute cholecystitis, 21 patients) and Group 2 (without cholecystitis, 65 patients). Clinicopathological comparisons were made and evaluated between these two groups

RESULTS

The average age of Group 1 patients was older than that of Group 2 patients (75+/-2 years vs. 63+/-2 years; p<0.05). Three Group 1 patients presented with sepsis. The interval between the onset of symptoms and hospital admission in Group 2 patients was significantly (p<0.05) longer than that in Group 1 patients (243+/-95 days vs. 20+/-11 days). Leukocytosis (>11,000/mm3) was more common in Group 1 patients than in Group 2 patients (47.6% vs. 15.4%). Jaundice was more common in Group 2, and fever was common in Group 1. The majority of Group 2 gallbladder cancers were stage V (75.4%). In contrast, 52.4% of Group 1 gallbladder cancers were stage III and 38.1% were stage V. The 30-day postoperative mortality rate in Group 1 and Group 2 patients was 9.5% and 7.7%, respectively. The cumulative survival of Group 1 patients was not different from that of Group 2 patients (log-rank test, p>0.05).

CONCLUSIONS

Age, the interval of symptoms prior to admission, the location of abdominal pain, fever, leukocytosis, and the absence of jaundice suggested the presence of acute cholecystitis in gallbladder carcinoma. A high index of suspicion of the disease, intraoperative examination of gallbladder specimens, and more aggressive surgical treatment may improve patient survival.

摘要

背景/目的：胆囊原发性癌较为罕见，常伴诊断延迟及预后不良。并发急性胆囊炎时，常掩盖癌的存在。关于合并急性胆囊炎的胆囊癌的资料有限。为更好地了解合并急性胆囊炎的胆囊癌的表现，我们回顾性分析了原发性胆囊癌患者的数据。

方法

收集并分析了1979年至1994年间接受治疗的86例原发性胆囊癌患者的数据。患者分为两组：第1组（合并急性胆囊炎，21例）和第2组（无胆囊炎，65例）。对两组进行临床病理比较和评估。

结果

第1组患者的平均年龄大于第2组患者（75±2岁 vs. 63±2岁；p<0.05）。第1组有3例患者出现脓毒症。第2组患者症状出现至入院的间隔时间显著长于第1组患者（243±95天 vs. 20±11天；p<0.05）。第1组患者白细胞增多（>11,000/mm³）比第2组更常见（47.6% vs. 15.4%）。黄疸在第2组更常见，发热在第1组常见。第2组大多数胆囊癌为V期（75.4%）。相比之下，第1组52.4%的胆囊癌为III期，38.1%为V期。第1组和第2组患者术后30天死亡率分别为9.5%和7.7%。第1组患者的累积生存率与第2组患者无差异（对数秩检验，p>0.05）。