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It was found that, in patients with operation of bile duct. 93. 6% of those cases receiving cholecystectomy plus explorative drainage of common bile duct suffered Yin - deficiency of the stomach, apparently higher than those cases receiving simple cholecystectomy plus choledochoduodenostomy and choledochojejunostomy (P<0. 01). This suggests that the loss of bile is the foot cause of Yin -deficiency of the stomach which can be treated with modified Yiwei Decoction, with an efective rate of 94. 6%. 通过对胆道术后病人的临床观察,发现行胆囊切除+胆总管探查引流术后有93.6%的病人出现胃阴虚证,明显高于行单纯胆囊切除术和作胆总管十二指肠吻合术、胆总管空肠吻合术者(P均<0.01),表明胆汁的丢失是造成术后胃阴虚证的根本原因。用益胃汤化裁治疗术后胃阴虚证有效率为94.6%。 Objective To summerize our experience for the diagnosis and surgical management for primary gallbladder cancer.MethodsIn this study the clinical data of 134 patients suffering from primary gallbladder carcinoma proved by both laparotomy and pathology in our hospital were retrospectively analyzed.Results Patients were 50 men 〔mean age (56±14) years〕 and 84 women 〔mean age (59±16) years〕,followed up for 6 months~16 years.The diagnostic accuracy of B ultrasound was 54 3%(88/162);of color Dopple ultrasound... Objective To summerize our experience for the diagnosis and surgical management for primary gallbladder cancer.MethodsIn this study the clinical data of 134 patients suffering from primary gallbladder carcinoma proved by both laparotomy and pathology in our hospital were retrospectively analyzed.Results Patients were 50 men 〔mean age (56±14) years〕 and 84 women 〔mean age (59±16) years〕,followed up for 6 months~16 years.The diagnostic accuracy of B ultrasound was 54 3%(88/162);of color Dopple ultrasound 69% (29/42);of contrast enhanced CT 85% (46/58).Simple cholecystectomy was performed in 6 patients of Nevin's stage Ⅰ,among them 4 cases have survived more than 5 years; 66 cases with Nevin's stage Ⅱ~Ⅳ carcinoma received radical cholecystectomy, the mean survival was 20 months; 17 patients of Nevin's stage Ⅴ received radical or extended radical cholecystectomy,the postoperative mean survival was 15 months whereas 10 patients with Nevin's stage Ⅴ undergoing palliative cholecystectomy had only a mean survival of 6 months; 35 patients with Nevin's stage Ⅴ undergoing a mere laparotomy survived an average of 2 months.Conclusions The colour Dopple ultrasound is the first line diagnostic means for early gallbladder cancer. Xanthogranulomatous cholecystitis should be carefully differentiated from locally advanced gallbladder cancer when a non surgical management was to be employed. Patients diagnosed with Nevin's stage Ⅴ gallbladder carcinoma should undergo laparotomy in an attempt to perform resection provided that the constitutional condition of the patients allows this procedure. 目的 总结胆囊癌的诊断和治疗经验。方法 对手术和病理确诊的胆囊癌 134例资料进行回顾性分析。随访 6个月至 16年。结果 B超检查正确率为 5 4 3% (88/16 2 ) ,电脑彩超正确率达 6 9% (2 9/4 2 ) ,CT结合增强扫描正确率达 85 % (46 /5 8)。NevinⅠ期 6例行单纯胆囊切除术 ,其中4例已生存 5年。NevinⅡ~Ⅳ期行胆囊癌根治性切除术 6 6例 ,平均生存 1年 8个月。NevinⅤ期行根治性或扩大根治性胆囊癌切除术 17例 ,平均生存期为 1年 3个月 ;10例NevinⅤ期行姑息性胆囊切除 ,平均生存 6个月 ;NevinⅤ期仅行剖腹探查术 35例 ,平均生存期仅 2个月。结论 电脑彩超可用做诊断早期胆囊癌的首选检查 ,晚期胆囊癌应与黄色肉芽肿性胆囊炎相鉴别。NevinⅤ期病人 ,只要没有腹水、凝血障碍和心肺肝肾的严重器质性病变 ,不应轻易放弃手术探查。 ?Objective:To evaluate methods of surgical treatment in carcinoma of gallbladder.Methods:Fifty-two cases of gallbladder carcinoma were operated according to Nevin's classification:8 cases of stage Ⅰ were operated with simple cholecystectomy in 4 and expansile cholecystectomy in 4;19 cases of stage Ⅱ\,Ⅲ\,Ⅳ were operated with expansile cholecystectomy and 25 cases of stage Ⅴ with super-expansile cholecystectomy in 8.Results:In follow-up study of 41 cases for 1\,3\,5 years,the patients in... ?Objective:To evaluate methods of surgical treatment in carcinoma of gallbladder.Methods:Fifty-two cases of gallbladder carcinoma were operated according to Nevin's classification:8 cases of stage Ⅰ were operated with simple cholecystectomy in 4 and expansile cholecystectomy in 4;19 cases of stage Ⅱ\,Ⅲ\,Ⅳ were operated with expansile cholecystectomy and 25 cases of stage Ⅴ with super-expansile cholecystectomy in 8.Results:In follow-up study of 41 cases for 1\,3\,5 years,the patients in Nevin stage Ⅰ survived after cholecystectomy were 4\,3\,2,respectively after expansile cholecystectomy in 4 were 100%;Patients of Nevin stage Ⅱ\,Ⅲ\,Ⅳ survived after expansile cholecystectomy were 12\,8\,5;Patients of Nevin stage Ⅴ survived after super-expansile cholecystectomy were 4\,3\,1.All 17 cases operated for laparotomy or bile internal or external drainage died in 10 months.Conclusions:In treatment of carcinoma of gallbladder,effect of expansile cholecystectomy is better than that of simple cholecystectomy in Nevin stage Ⅰ.Expansile cholecystectomy with elimination of regional lymph nodes in Nevin stage Ⅱ\,Ⅲ\,Ⅳ and super-expansile cholecystectomy in Nevin stage Ⅴ significantly increase survival rate of patients with carcinoma of gallbladder. 〔 目的 :探讨胆囊癌的手术治疗。方法 :5 2例胆囊癌按Nevin分期采用不同手术方法。NevinⅠ期 8例 ,4例行单纯胆囊切除术 ,4例行扩大的胆囊切除术 ;NevinⅡ、Ⅲ、Ⅳ期 19例 ,行扩大胆囊切除术 ;NevinⅤ期 2 5例 ,8例行超扩大胆囊切除术。结果 :随访 41例 ,各组 1、3、5年生存率 :Ⅰ期 8例 ,4例行单纯胆囊切除术 ,生存数分别为 4例、3例和 2例 ,4例行扩大的胆囊切除术均存活 ;Ⅱ、Ⅲ、Ⅳ期 17例 ,行扩大的胆囊切除术生存数分别为 12例、8例和 5例 ;Ⅴ期 8例行超扩大胆囊切除术生存数分别为 4例、3例和 1例 ,行剖腹活检或内外引流的 17例均在 10个月内死亡。结论 :Ⅰ期扩大胆囊切除优于单纯性胆囊切除术 ,Ⅱ、Ⅲ、Ⅳ期应采用扩大胆囊切除术 ,并注意清扫局部淋巴结 ,Ⅴ期在条件许可时采用超扩大胆囊切除术 ,可明显提高术后生存率
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