胆囊癌的诊断与治疗进展

乐羿; 杨豪; 刘虎; 崔昭扬; 赵向宁; 安亮; 李海珠; 张绍庚

doi:10.3969/j.issn.1001-5256.2023.11.032

胆囊癌的诊断与治疗进展

DOI: 10.3969/j.issn.1001-5256.2023.11.032

上海孟超肿瘤医院肿瘤外科，上海 201805

基金项目:

上海市嘉定区卫生健康委科研立项项目 (2022-KY-19)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：乐羿、杨豪负责课题设计，资料分析，撰写论文；刘虎、崔昭扬、赵向宁、安亮、李海珠参与收集及分析数据；乐羿、杨豪、张绍庚负责修改论文；张绍庚负责指导写作思路，指导撰写文章并最后定稿。

详细信息

通信作者:
张绍庚， zhangsg302@hotmail.com （ORCID： 0000-0003-0680-2322）

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出版历程
- 收稿日期: 2023-03-14
- 录用日期: 2023-03-22
- 出版日期: 2023-11-28

Advances in the diagnosis and treatment of gallbladder carcinoma

Department of Tumor Surgery，Shanghai Mengchao Cancer Hospital，Shanghai 201805，China

Research funding:

Scientific Research Project approved by Health Commission of Jiading District, Shanghai (2022-KY-19)

More Information

Corresponding author: ZHANG Shaogeng， zhangsg302@hotmail.com （ORCID： 0000-0003-0680-2322）

摘要

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。
- 胆囊肿瘤 /
- 危险因素 /
- 诊断 /
- 治疗学
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.
- Gallbladder Neoplasms /
- Risk Factors /
- Diagnosis /
- Therapeutics

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图 1 胆囊解剖结构

Figure 1. Anatomy of the gallbladder

下载: 全尺寸图片幻灯片

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
由沙门菌、副伤寒沙门菌或伤寒沙门菌引起的慢性感染	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	遗传因素
肥胖	自由基氧化产物

下载: 导出CSV

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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