目的 探讨腹腔镜辅助下术中或术后意外发现的早期胆囊癌行根治术的可行性.方法 回顾性分析2007年1月至2013年8月在我科腹腔镜下胆囊切除术中或术后病理发现的34例原发性胆囊癌患者的临床资料.其中29例为术中快速病理确诊为胆囊癌,5例为术后病理确诊为Ⅰ期、Ⅱ期胆囊癌.结果 34例患者均成功完成了标准的胆囊癌根治术,其中20例Ⅰ期、Ⅱ期和Ⅲ期中肿瘤仅浸透浆膜,或肿瘤侵犯肝的深度不足2 cm的患者行腹腔镜下单纯胆囊切除术或根治性/扩大根治性胆囊切除术,9例中转开腹行根治性/扩大根治性胆囊切除术或联合肝段/叶切除的胆囊根治性切除术.5例单纯胆囊切除术后病理确诊为胆囊癌的患者再次行腹腔镜下胆囊癌根治性/扩大根治性手术.结论 胆囊癌Ⅰ期、Ⅱ期和Ⅲ期中肿瘤仅浸透浆膜,或肿瘤侵犯肝的深度不足2 cm的患者均应行根治性或扩大根治性胆囊切除术.行腹腔镜辅助下根治性或扩大根治性胆囊切除术短期治疗效果满意,5年生存率两者差异无统计学意义.且具有更低的疼痛不适率,更短的住院时间,可以达到与开腹同样的手术效果,达到了根治的要求.

Objective To explore the feasibility of radical cholecystectomy for early gallbladder car cinoma found during or after laparoscopic cholecystectomy.Methods A retrospective study was conducted on patients who received laparoscopic cholecystectomy between January 2007 to August 2013 and were diagnosed to have gallbladder cancer during or after the operation.There were 34 patients.In 29 patients intraoperative frozen section diagnosed gallbladder carcinoma.In 5 patients postoperative histopathological study diagnosed stage Ⅰ or Ⅱ gallbladder carcinoma.Results Surgery was conducted successfully on these 34 patients.In 20 patients with stage Ⅰ,Ⅱ and Ⅲ,the tumor had invaded the serosa,or into the liver with a depth of less than 2 cm,laparoscopic cholecystectomy alone or radical/extended radical cholecystectomy were carried out.In 9 patients,the laparoscopic surgery was converted to open surgery and these patients underwent cholecystectomy with resection of the adjacent liver s

TNM分期系统是目前国际上最为通用的肿瘤分期系统。精确和客观的分期是胆囊癌合理治疗的必要前提。本文拟解读最新版的胆囊癌TNM分期,以规范和指导胆囊癌的手术治疗。

TNM staging system is most widely used in tumor staging. Precise and objective staging is the necessary premise in treating gallbladder carcinoma.This paper is to standardize and guide the operative treatment by understanding the latest TNM staging of gallbladder carcinoma.

目的：探讨c-Myc、k-Ras、p16蛋白在胆囊癌细胞中的表达及临床意义。方法：收集20例胆囊癌、50例慢性胆囊炎和20例正常胆囊组织标本，用免疫组化法检测c-Myc、k-Ras、p16蛋白的表达，分析三种蛋白表达与胆囊癌的临床病理特征关系。结果：c-Myc、k-Ras蛋白定位于细胞质和细胞核中，在胆囊癌中的表达程度明显高于慢性胆囊炎和正常胆囊，差异有统计学意义（P＜0.01）。p16定位于胞质，在胆囊癌中的表达程度明显低于正常胆囊和慢性胆囊炎，差异有统计学意义（P＜0.01）。c-Myc表达程度与肿瘤大小、分化和淋巴结转移密切相关（P＜0.05）；k-Ras表达程度与肿瘤大小、侵犯深度和淋巴结转移密切相关（P＜0.05）。结论：c-Myc、k-Ras、p16蛋白在胆囊癌细胞中呈异常表达，其表达与临床病理特征相关，可能在胆囊癌发生发展中起有重要作用。

Objective:To investigate the expressions of c-Myc, k-Ras and p16 protein in the gallbladder carcinoma cells and their clinical implication. Methods:The expressions of c-Myc, k-Ras and p16 protein were detected in 20 cases of gallbladder carcinoma, 50 cases of chronic cholecystitis and 20 cases of normal gallbladder tissue specimens with the immunohistochemical method. The relationships of the expressions of three kinds of proteins with the clinical pathological characteristics were assayed. Results:The c-Myc and k-Ras expressions were localized in the cytoplasm and nucleus of tumor cells, and the expressions in gallbladder carcinoma were signiifcantly higher than those in chronic cholecystitis and the normal gallbladder, whose difference had the statistical signiifcance (P<0.01). The location of p16 protein was found in the cytoplasm. The expression degrees in the gallbladder carcinoma were obviously lower than those in the normal gallbladder and chronic cholecystitis, whose

目的 总结胆囊小细胞癌(gallbladder small cell carcinoma,GSCC)的临床病理特点,探讨其诊断及治疗方法.方法 回顾性分析中国医学科学院肿瘤医院2000-2012年收治的5例GSCC患者的临床及病理资料.结果 5例患者中男1例,女4例,初次就诊年龄在42 ～ 67岁(中位年龄57岁),均以非典型的右上腹疼痛、不适为初始主诉;肿瘤位于胆囊底部3例,胆囊体部2例;4例患者伴有胆石症.2例行根治性胆囊切除术,术后辅以EP(依托泊苷+顺铂)方案化疗6个周期,1例行放射治疗1次,2例患者分别随访至术后45和32个月,生存良好;3例行姑息性胆囊切除术,术后行辅助性化放疗,分别于术后8、11及30个月死于肿瘤广泛播散转移.结论 GSCC为临床少见的恶性肿瘤,初期症状不典型,确诊率低,病情进展迅速且预后相对较差;肿瘤根治切除可以显著延长患者的生存期,以手术为主的综合治疗仍是GSCC的主要治疗手段.

Objective To study the clinical features of gallbladder small cell carcinoma (GSCC),to improve the diagnosis and treatment of GSCC.Methods We retrospectively analyzed the clinical data of GSCC patients at our hospital from January 2000 to January 2012,and made a collective review of the literature.Results In this series,there were four female cases,one male case,the age at the first diagnosis was between 42-67,with the median age of 57.The main complain was pain and dis-comfort on the up and right abdomen.Tumor located in the bottom of gallbladder in 3 cases,and in the body in 2.Cholelithiasis was complicated in 4 cases.2 patients received radical resection of GSCC,followed by adjuvant chemotherapy of VP-16 and cisplatin,radioactive therapy in one.Postoperatively,these two were followed up for 45 and 32 mons with tumor free survival.3 cases received palliative resection,followed by adjuvant chemoradioactive therapy or intervention treatment,these three were followed up to 8,11,30 month

胆囊癌作为一种常见的恶性肿瘤疾病，给患者的身心健康带来很大的影响，胆囊癌在早期发现早期治疗的话，会极大提高胆囊癌的治愈率，对于患者来说，除了肿瘤治疗外，还要做好疾病的护理措施，消除患者及家属的顾虑与紧张心理，坚定战胜疾病的信心；术后科学的调整患者的饮食结构，加强患者与癌症抗争的能力。

gallbladder as a kind of common malignant tumor diseases,brings to the patient′s physical and mental health is very big,the influence of the gallbladder in early found early treatment,will greatly enhance the cure rate of gallbladder,for patients,in addition to tumor treatment,need to get disease nursing measures,to eliminate worries of patients and families with nervousness,firm confidence to conquer the disease;Postoperative patients with scientific adjustment of dietary structure,strengthen the ability of patients with cancer.