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众所周知进展期胆囊癌预后很差。多数第Ⅴ期胆囊癌患者已有肝脏浸润或其他器官浸润。作者1986年报告了13例进展期胆囊癌患者经积极手术,其中2例早期患者术后分别已存活12年和13年。因胆囊癌术后能存活10年以上极少见,故作报道。 例1,男,59岁,因黄疸住院。PTCD后血清胆红素降至1.0mg/dL以下。经PTCD导管造影同时ER以CP示总胆管上段4.5cm梗阻。肝动脉造影右肝动脉有鞘状包裹,门脉正常。诊断:进展期胆囊癌。化疗三个月无效果,行右肝三叶切除和局部淋巴结清除术。因门静脉主干右侧壁有肿瘤浸润故切除门静脉主干3cm,并作吻合。术后5天内有短暂精神紊乱,支链氨基酸和芳香族氨基酸比率缩小,血清甲硫氨基酸浓度增加。右胸少量渗液、轻度胆瘘均在2周内消失。术后28天出院。病理学检查肝外胆管周围组织
It is well known that the prognosis of advanced gallbladder cancer is poor. Most patients with stage V gallbladder cancer have liver infiltration or other organ infiltration. The authors reported in 1986 that 13 patients with advanced gallbladder cancer had undergone active surgery, and 2 of the early patients had survived 12 and 13 years after surgery, respectively. It is rare to report that gallbladder cancer can survive for more than 10 years after surgery. Example 1, male, 59 years old, hospitalized due to jaundice. After PTCD serum bilirubin fell below 1.0 mg/dL. At the same time, the ER showed CP obstruction in the upper bile duct with PTCD catheter. Hepatic arteriography The right hepatic artery has a sheath-like wrap and the portal vein is normal. Diagnosis: advanced gallbladder cancer. After three months of chemotherapy, there was no effect. Right hepatectomy and regional lymph node dissection were performed. Since the right portal vein of the portal vein had tumor invasion, the main portal vein was removed 3 cm and anastomosis was performed. There were transient mental disorders within 5 days after surgery, the ratio of branched-chain amino acids and aromatic amino acids was reduced, and serum methosulfuric acid concentrations increased. A small amount of exudate and mild bile of the right chest disappeared within 2 weeks. Discharged 28 days after surgery. Pathological examination of extrahepatic bile duct tissue