tory burch shoes trr tdu eydj qpm

asbryobvrz · Wysłany: Nie 18:21, 06 Mar 2011

Diagnosis and treatment of 35 patients with primary gallbladder carcinoma

, Common bile duct incision cholecystectomy + + gastrectomy, 1 case Gastrojejunostomy + the right gastroepiploic artery Author: 31451l Tongxiang, Zhejiang Province, Tongxiang City Second People's Hospital,[link widoczny dla zalogowanych], Chang Jin-Gen Shen Yun Jin Chunrong Chenzong Long subcutaneous buried Pumps 1 patients, cholecystectomy + ostomy + gastric resection and duodenal fistula transverse suture in 2 cases, biopsy alone in 3 cases. Non-surgical survival time of less than 1 year. Surgery 1, 3, 5-year survival rates were 32.14% (9 / 2 Cool

, 21.42% (6 / 2 Cool

and 3.57% (1./28.) 28 cases of 4 patients are currently alive, the time was 47 months, 28 months, 15 months, 6 months. 2 2.1 The cause of the discussion: in recent years as imaging technology continues to improve, gradually increased the detection rate of gallbladder carcinoma, but its real etiology is not clear. Possible factors: ④ with gallbladder stones caused by chronic inflammation caused by long-term stimulation. China reports 20% -82,[link widoczny dla zalogowanych],6% of the gallbladder associated with stone Ill, and gallbladder stones, about 1.5% -6%, gallbladder cancer combined. Those suffering from gallstones the relative risk of gallbladder stones is 6-15 times the no. Stone with this group was 74.3%. ② lesions of gallbladder: Gallbladder polyps have been proved to be precancerous lesions,[link widoczny dla zalogowanych], and adenocarcinoma associated with malignant transformation of gallbladder stones more likely. Gallbladder polyps is generally believed that more than 0.5cm in diameter may be considered malignant. The group 1 patients, but polyp was 0.7cm, with gallbladder polyps with stones cholecystectomy, pathologically confirmed as poorly differentiated adenocarcinoma. ③ biliary enteric fistula: long-term presence of gallbladder fistula will result in increased incidence of gallbladder ridicule. 2.2 Diagnosis: lack of specific clinical manifestations of early gallbladder cancer, diagnosis often easy to delay. Right upper quadrant pain was the most common symptoms, about 80% of patients with right upper quadrant pain as initial symptoms. B-is currently considered an effective early diagnosis and easy way, the diagnostic accuracy rate of 85% -90%. B-diagnosed in this group was 42.9%. The group of B-diagnosis of the main reasons for the low rate: B super-sensitive abdominal wall thickening, bowel pneumatosis and other factors, reflects the difference of atrophic cholecystitis (6 cases in this group.) Because of medical technology and clinical doctors often meet in the diagnosis of common diseases, not enough to guard against the disease,[link widoczny dla zalogowanych], lack of understanding of imaging (B-3 patients in this group described as irregular thickening of gallbladder wall thickening or apparent). CT diagnosis in this group was 73.3%. CT examination can make a diagnosis of gallbladder cancer, but also to better show the tumor extent and relationship with the surrounding tissue, a clear local invasion and distant metastasis, there is guidance on the operation. For non-specific symptoms of right upper quadrant, at a good age should be routinely performed in patients with liver and gallbladder ultrasound B [41. 5 patients in this group denied a history of biliary tract, have long-term For gallbladder stones, gallbladder polyps in patients with B-ultrasound should be recommended on a regular basis. The following should be included in the gallbladder in patients with high-risk groups: ① gallbladder stones in older women; ② years of history of cholelithiasis and repeatedly made; ③ the changing nature of abdominal pain, gallbladder stones, into persistent dull pain, pain, can not ease for several weeks , and continue to have gastrointestinal symptoms, weight loss, anemia; ④ B-Tip gallbladder wall thickening or wall calcification, atrophic cholecystitis; ⑤ gallbladder polyps larger than 0.5cm in diameter,[link widoczny dla zalogowanych], although smaller than the lesions or However, gallbladder stones 0.5cm; ⑥ associated with intestinal fistula bile of gallstones in those. 2I3 treatment and prognosis: the treatment of gallbladder cancer to surgery. At present, there are three kinds of operation types: ① simple cholecystectomy; ② extended cholecystectomy; ③ palliative surgery. However, due to the early detection and diagnosis of gallbladder cancer is low, the prognosis is poor, the overall 5-year survival rate of less than 5%. About 75% of patients in surgery over the possible removal of the tumor range. For patients with advanced, expanding the scope of surgical resection is not helpful [51. The key outcome of gallbladder cancer depends on early diagnosis, treatment and stage are closely related.