| Objective: The primary carcinoma of gallbladder (PCG), which accountsfor two thirds of the biliary tumor, is the most common one in the malignantdisease of biliary system. It can be easily confused with some benign diseases,such as cholecystolithiasis, gallbladder polyps, cholecystitis and so on, forlacking of characteristic symptoms and signs during its early phase and it isusually in the advanced phase when upper abdominal pain, dyspepsia,jaundice and other symptoms have presented. The resection rate and5-yearsurvival rate of advanced gallbladder carcinoma are low, while the5yearssurvival rate of early gallbladder carcinoma could reach100%. This paperfocuses on analyzing the clinical characters of PCG, exploring the relatedparameters for the diagnosis of early gallbladder carcinoma to improve thediagnostic rate and prognosis and discussing the relationship between theoperation methods and the prognosis.Method: Patients with gallbladder carcinoma and being treated in theHepatobiliary Department of the Second Affiliated Hospital of Hebei MedicalUniversity between2002.1to2011.1were involved in this paper.80patientswere excluded for repeated admission, complicating other severe diseases orincomplete following-up data.90patients with cholecystolithiasis orgallbladder polyps treated in our hospital were randomly selected as thecontrol group. And all these cases were analysed with comparison betweengroups and single and multiple logistic regression.Result: There were80cases in the gallbladder carcinoma group, ofwhich45were male(56.3%),35were female(43.8%), the oldest was81yearsold, the youngest was30years old,75cases were older than75(93.75%) andthe mediate age was64.5years old. There were90cases in the control group,of which39were male (43.33%),51were female(56.67%), the oldest was85years old, the youngest was19years old,51cases were older than50(56.67%) and the mediate age was56years old. Between these two groups, a significantdifference (P<0.001) in suffering age could be found. And there were alsosignificant differences(P<0.001) in that whether the patients were withabdominal distention, dyspepsia (59out of80cases in PCG group and23outof90cases in control group), whether there was space-occupying lesions(SOL) in gallbladder(66out of80cases in PCG group and23out of90casesin control group), whether there was thick gallbladder wall(74out of80casesin PCG group and8out of90cases in control group), whether there wereswelling lymph nodes(65out of80cases in PCG group and1out of90casesin control group), whether there was intra-or extra-hepatic cholangiectasis (37out of80cases in PCG group and2out of90cases in control group).In PCGgroup, patients with abnormal CEA value, CA199value or CA125value wererespectively20,65and37cases, and a significant difference(P<0.001) wasfound when compared with the control group. In laboratory examinations,there were significant differences(P<0.001)in HGB,TBIL, DBIL, IBIL,ALT,AST, ALP, rGGT and TBA between the PGC group and control group;in imaging examination, the preoperative localization accuracy ofB-ultrasonography and computed tomography(CT)Was61.29％(38／62) and87．18％(68／78)．72out of80cases in the PCG group underwent operationtreatment;2patients were performed laproscopic cholecystectomy alone；19patients were performed radical surgery；14patients were performed extendedradical gallbladder surgery；10patients were performed open-shut operationfor extensive metastasis．Pathological types:56cases of adenocarcinoma(82.4％),6cases of squamous cell carcinoma(8.8%),2cases ofadenosquamous carcinoma(2.9%),2cases of carcinoid tumers(2.9%),2casesof undifferentiated carcinoma(2.9%)．Pathological stage(in accordance withthe International Union Against Cancer(UICC) released TNM stagingcriteria):0stage of0case,I stage of2cases,II stage of9cases,III stage of23cases,IV stage46cases．46patients have been followed-up with thefollowing-up rate of57.5％(46／80)．5patients with II stage have beenfollowed—up,including2cases survived1year,2cases survived2years,1 cases survived5years.11patients with III stage have been followed—up,including3cases survived1year,2cases survived3years,6cases deadwithin1year.28patients with IV stage have been followed-up,including2cases survived1year,26cases dead within1year. The overall1-year survivalrate was30.43％(14／46) and5-year survival rate was4.35％(2／46)．Conclusion:1. Primary gallbladder carcinoma is mostly related tochronic cholecystitis, cholecystolithiasis and gallbladder polyps with insidiousonset.2. There are no characteristic clinical manifestations for primarygallbladder carcinoma while the abdominal ultrasonography, computerizedtomography and laboratory examinations including tumor marker detectioncould benefit the preoperative diagnosis.3. Surgery is the first choice for PCGand the survival rate of the patients with advanced gallbladder carcinomacould be improved by radical surgery.4.Controlling the risk factors couldimprove the prognosis, which is not good, by preventing the occurrence ofgallbladder carcinoma. Early screening of the high risk population ofgallbladder carcinoma is the key point to the clinical treatment.5. The clinicalstage of gallbladder carcinoma greatly influence the prognosis. And improvingthe early dignostic rate is the key point to improve the diagnostic andtreatment level. |
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