中国实用外科杂志

中国实用外科杂志 ›› 2011, Vol. 31 ›› Issue (03): 215-219.

• 专题笔谈 • 上一篇    下一篇

晚期胆囊癌的姑息性治疗

胡志前，姚厚山   

  1. 第二军医大学附属长征医院普通外科，上海 200003
  • 出版日期:2011-03-01 发布日期:2011-05-30

  • Online:2011-03-01 Published:2011-05-30

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摘要：

多数胆囊癌病人在就诊时已属晚期，手术切除率低，目前胆囊癌的治疗效果还不甚理想。姑息性治疗包括姑息性手术、辅助放化疗、靶向治疗及中医中药治疗等。解除黄疸是胆囊癌姑息性手术的主要目的，应尽量考虑作内引流术。辅助放疗对伴有淋巴结转移和局部浸润的胆囊癌病人是有益的，放射剂量越高对肿瘤控制效果越好，为了降低毒副反应，可行放疗强度调节治疗。胆囊癌的辅助化疗方案应包含gemcitabine，与柏类或阿霉素类联合可能会增加其疗效。胆囊癌靶向治疗还处于起步阶段，还没有成熟的药物用于胆囊癌的靶向治疗。总体来说，目前有关胆囊癌的姑息性治疗的研究还比较局限，尚需开展多中心的前瞻性临床试验来评价出较好的胆囊癌辅助治疗方案，以延长胆囊癌病人的生存期。

关键词: 胆囊癌, 姑息性治疗, 辅助治疗

Abstract:

Palliative treatment of advanced gallbladder carcinoma        HU Zhi-qian, YAO Hou-shan. Department of General Surgery, Shanghai Changzheng Hospital, the Second Military Medical University，Shanghai 200003, China
Corresponding author: HU Zhi-qian, E-mail:huzq62@163.com
Abstract Gallbladder carcinoma (GBC) is often at an advanced stage when diagnosis is made. The majority of patients with advanced GBC have been unresectable, and overall prognosis in patients with GBC is dismally poor. The palliative treatment of gallbladder carcinoma from palliative operation, adjuvant chemotherapy, adjuvant radiation therapy and traditional Chinese drug is studied. Draining bile is the major reason for palliative operation in patients with gallbladder carcinoma, and internal drainage should be the primary option. Adjuvant radiation therapy is beneficial for gallbladder carcinoma with regional infiltration or lymph metastasis. The control of tumor progression is determined by radiation dosage. Intensity-modulated radiation therapy leads to less toxicity with the same effect. Adjuvant chemotherapy regime of gallbladder carcinoma should include Gemcitabine. The curative effect of Gemcitabine will enhance if it combined with platinums or adriamycin. The molecular target therapy of gallbladder carcinoma is at initial stage with no agent recommended at present. In conclusion, study of palliative treatment of gallbladder carcinoma remains limited. More multicentre prospective studies are needed to asses the adjuvant treatments of gallbladder carcinoma.

Key words: gallbladder carcinoma, palliative treatment, adjuvant therapy