胆囊癌的诊断与治疗进展
DOI: 10.3969/j.issn.1001-5256.2023.11.032
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摘要: 胆囊癌是胆道系统常见的恶性肿瘤,早期症状特异性差,恶性程度极高,进展迅速,难以早期诊断。胆囊结石、胆囊息肉等被认为是最常见的危险因素。超声检查是其首选检查,CT、MRI、PET等也各具优势。胆囊癌缺乏根治性治疗手段,外科手术仍是胆囊癌首选的治疗方式,但其进展迅速,很多患者确诊时已难以行手术治疗,放化疗、靶向治疗、免疫治疗等多种治疗方式联合,在一定程度上改善了患者预后,但其远期治疗效果仍不理想,因此,预防为主、治疗为辅,早发现、早治疗显得尤为重要。Abstract: Gallbladder carcinoma is a common malignant tumor of the biliary system characterized by poor specificity of early symptoms, a high degree of malignancy, and rapid progression, and it is difficult to make an early diagnosis. Gallstones and gallbladder polyps are considered the most common risk factors for gallbladder carcinoma. Ultrasound is the preferred examination, while CT, MRI, and PET also have their own advantages. There is a lack of radical treatment methods for gallbladder carcinoma, and surgical operation remains the preferred treatment method for gallbladder carcinoma; however, due to the rapid progression of this disease, most patients have lost the opportunity for surgery at the time of diagnosis. A combination of various treatment modalities, such as radiochemotherapy, targeted therapy, and immunotherapy, has improved the prognosis of patients to a certain extent, but with an unsatisfactory long-term therapeutic effect. Therefore, it is of particular importance to give priority to prevention rather than treatment and emphasize early identification and treatment.
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Key words:
- Gallbladder Neoplasms /
- Risk Factors /
- Diagnosis /
- Therapeutics
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表 1 GBC危险因素
Table 1. Risk factors of GBC
主要独立病因 依赖性病因 年龄 吸烟史 性别,身体质量指数 芥末油、鱼腥草酮油和黄油黄 家族史 早年怀孕 胆囊结石 使用口服避孕药 慢性胆囊炎 红辣椒 由沙门菌、副伤寒沙门菌或 伤寒沙门菌引起的慢性感染 职业暴露,苯 次级胆汁酸含量 幽门螺杆菌 黄色肉芽肿性胆囊炎 胰胆管汇流异常、先天肝外 胆管囊肿 重金属 胆囊息肉 遗传因素 瓷化胆囊 肥胖 自由基氧化产物 表 2 胆囊癌分期与手术方式
Table 2. Staging and surgical methods of GBC
TNM分期 临床分期 术式 原发性肿瘤(T) Tis:原位癌 0期:Tis、N0、M0 单纯胆囊切除 T1a:侵及固有层 1期:T1、N0、M0 T1b:侵及肌层 2A期:T2a、N0、M0 单纯胆囊切除术+肝十二指韧带淋巴结清扫 T2a:侵及腹膜面的肌周结缔组织,但 未穿透浆膜 2B期:T2b、N0、M0 胆囊癌根治术+胆囊床肝组织切除+胆囊三角清扫+肝十二指肠韧带、肝总动脉旁、十二指肠周围、胰头后方、肠系膜上动脉周围淋巴结清扫 T2b:或侵及肝脏面的肌周结缔组织, 但未进入肝脏 3A期:T3、N0、M0 T3:穿透浆膜和/或直接侵入肝脏和/ 或一个邻近器官或结构,如胃、十二 指肠、结肠、胰腺、网膜或肝外胆管 3B期:T1~3、N1、M0 扩大胆囊癌根治术+受浸润肝段/半肝切除+淋巴结扩大清扫 T4:侵及门静脉,或肝动脉,或两个或 更多肝外器官或结构 4A期:T4、N0~1、M0 区域淋巴结转移情况(N) 4B期:任何T、N2、M0,或任何T、 任何N、M1 远处脏器、淋巴结转移,无法R0切除,应避免手术,保守治疗 N0:无区域淋巴结转移 N1:1~3枚区域淋巴结转移 N2:4枚以上区域淋巴结转移 远处转移(M) M0:无远处转移 M1:有远处 -
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