The principles of surgical treatment of gallbladder carcinoma

Gallbladder surgery What principle?
    (1) occult gallbladder principles of radical surgery, occult gallbladder cancer is preoperative, intraoperative diagnosis were not obtained, and in the result of "benign" disease after cholecystectomy gallbladder You were diagnosed as pathological . Because it is diagnosed after surgery, so the problems that the need for further radical surgery. If the pathological biopsy revealed cancer invasion to the mucosal layer only, or muscle layer, simply complete line of radical cholecystectomy has reached the purpose, may need further surgery for the second radical. Lymph node metastasis of gallbladder carcinoma involving the first triangle and the gallbladder lymph nodes along the common bile duct distribution. While in the gallbladder neck, especially the cystic duct cancer, gallbladder due to location close to triangular, so the earlier of the lymph node metastasis. Gallbladder neck cancer recurrence rate was significantly higher than the body at the bottom of gallbladder cancer group. Therefore, in the gallbladder neck, cystic duct of occult gallbladder, regardless of their violations to which layer of the gallbladder wall should be re-line around the hepatoduodenal ligament lymph node dissection. For more than myometrial invasion, positive margin and the cystic triangle lymph node biopsy-positive occult gallbladder is also a second radical operation should be OK.
(3) palliative advanced gallbladder surgery: For the incurable cases of advanced gallbladder carcinoma, surgical principle to reduce pain and improve quality of life. Advanced gallbladder more prominent issue is due to violation of biliary tract cancer caused by obstructive jaundice. Surgery should be considered for internal drainage. Methods of internal drainage of bile duct anastomosis, etc., but because of local tumor infiltration are deeper, particularly those associated with hilar invasion, biliary enteric drainage often not easy. On these patients, viable bridge internal drainage. For the case of poor general condition, but also feasible catheter drainage. For serious violations of hepatic portal can not line the surgery, curettage and aspiration can be used cut right liver, the expansion of the hepatic duct right hepatic looking to line tube drainage.
5-year survival rate of gallbladder cancer is very low, about 2% to 5%; 80% of patients can die within 1 year. If only the invasion and the gallbladder mucosa and submucosa, the prognosis for cholecystectomy is better, it was reported that 5-year survival rate for this group of patients up to 40% to 64%. Therefore, the key is good or bad prognosis of early diagnosis and timely treatment.
(2) gallbladder cancer radical operation; doctor as often in patients with gallbladder cancer is not early, according to the bulk case analysis, can be radical resection of gallbladder cancer only about 23%. The median overall survival in patients with gallbladder cancer is 3 months. Therefore, some surgeons pessimistic about the treatment of gallbladder cancer. In recent years, radical surgery on the gallbladder to carry out, after 5-year survival rate has improved significantly. The scope of radical surgery include cholecystectomy, liver resection and lymph node dissection. Normal liver around the gallbladder bed resection of 3 cm or so. Lymph node metastasis according to their convergence means and circumstances. General cleaning to the next lymph node metastatic lymph nodes. Early gallbladder cancer as long as the removal of the gallbladder lymph nodes, but most of the gallbladder should be resectable liver ligament lymph node dissection, if necessary, should be clean pancreaticoduodenal, the pancreatic lymph nodes.