RADICAL OPERATIONS FOR CARCINOMA OF THE GALLBLADDER - PRESENT STATUS IN JAPAN
RADICAL OPERATIONS FOR CARCINOMA OF THE GALLBLADDER - PRESENT STATUS IN JAPAN
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DOI：
10.1007/bf01658725
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发表时间：
1991-05-01
影响因子：
2.6
通讯作者：
TABATA, M
中科院分区：
文献类型：
--
作者：
OGURA, Y;MIZUMOTO, R;TABATA, M
根据1686例胆囊癌切除病例的组织学检查结果以及日本172家主要医院的手术结果，从癌浸润深度与手术结果的关系来评估根治性手术的现状。 癌浸润深度分为5组，即局限于粘膜层（m）的占11.9%，进展至固有肌层（pm）的占9.8%，延伸至浆膜下层（ss）的占29.6%，浆膜受累（se）的占21.8%，癌侵犯邻近器官（si）的占26.9%。 ss、se 和 si 患者比 m 和 pm 患者更常见肿瘤扩展，如淋巴结转移、淋巴管和静脉血管侵犯以及神经周围浸润。 m和pm患者的累积5年生存率为82.6%和72.5%，显着高于ss、se和si患者的37.0%、14.7%和7.5%。 手术方式的选择应取决于癌浸润的深度。 单纯胆囊切除术仅适用于肿瘤仅限于粘膜的患者，而对于癌症侵犯粘膜以外的患者，应进行更彻底的手术，例如扩大胆囊切除术。 胰十二指肠切除术适用于胰头后淋巴结转移并侵犯十二指肠的患者。 当肿瘤直接侵犯肝脏时，建议进行肝大部切除术。 由于术后发病率和死亡率较高，扩大右肝叶切除术联合胰十二指肠切除术仅适用于年龄小于 70 岁的晚期癌症且营养状态良好的患者。
Based on the histological findings of 1,686 resected cases of gallbladder carcinoma and operative results collected from 172 major hospitals in Japan, the present status of radical operation was assessed with respect to the relationship between the depth of carcinoma invasion and the operative results. The depth of carcinoma invasion was classified into 5 groups, i.e., limited to the mucosal layer (m) in 11.9%, advanced to the proper muscle layer (pm) in 9.8%, extending to the subserosal layer (ss) in 29.6%, serosal involvement (se) in 21.8%, and carcinoma invading the adjacent organs (si) in 26.9%. Tumor extension, such as lymph node metastasis, invasion of lymphatic and venous vessels, and perineural infiltration, were observed more frequently in patients with ss, se, and si than in those with m and pm. The cumulative 5-year survival rates were 82.6% and 72.5% in patients with m and pm, which were significantly higher than 37.0%, 14.7%, and 7.5% in those with ss, se, and si, respectively. The choice of operative procedures should depend on the depth of carcinoma invasion. Cholecystectomy alone is done only in patients with tumor limited to the mucosa, and more radical procedures such as extended cholecystectomy should be performed in those with carcinoma invasion beyond the mucosa. Pancreatoduodenectomy is indicated in those with lymph node metastasis posterior to the head of the pancreas and with invasion to the duodenum. When the tumor directly invades the liver, major hepatic resection is recommended. Extended right hepatic lobectomy with pancreatoduodenectomy should be reserved only for those younger than 70 years of age with advanced carcinoma and in a good nutritional state because of the high postoperative morbidity and mortality.