摘要
Abstract
Objective To analyze the causes and preventive measures of preoperative misdiagnosis or missed diagno-sis of gallbladder cancer.Methods The clinical data of 14 patients with misdiagnosed and missed gallbladder cancer admit-ted from January 2020 to August 2022 were retrospectively analyzed.Results Of the 14 cases,4 had a history of gallstones for many years.There was right upper abdominal pain and discomfort in 14 cases,nausea and vomiting in 6 cases,anorexia and emaciation in 11 cases,fatigue in 5 cases,fever in 2 cases,skin sclera yellow staining in 8 cases.All 14 cases were ex-amined by ultrasound,and 3 cases showed a single raised round or oval strong light mass of gallbladder,which did not change with body position.In 11 cases,there were multiple strong echo light clusters in the lumen of the sac,followed by the posteri-or tail shadow,and the position of the strong echo light cluster would change correspondingly when the body position changed.The preliminary diagnosis was cholecystolithiasis in 11 cases and polyps in 3 cases.All cases underwent laparoscopic cholecys-tectomy.Nodular masses were found in the body of the gallbladder in 11 cases of gallstones.The postoperative pathological ex-amination all indicated papillary adenocarcinoma of the gallbladder.The misdiagnosis lasted 3-5 d.Eight patients with stage Ⅱ and three patients with stage Ⅲ underwent postoperative adjuvant chemotherapy.At 2-year follow-up,4 cases were lost to follow-up,4 cases died and 6 cases survived.Conclusion The early symptoms of gallbladder cancer are varied,and it is of-ten combined with benign gallbladder lesions.The specificity of early ultrasonography is not high,which leads to high preoper-ative misdiagnosis or missed diagnosis rate.Strengthening the understanding of the risk factors of gallbladder cancer,gaining insight into the characteristics of its likelihood to coexist with other biliary diseases,reasonable selection of examination meth-ods and pathological examination when necessary,can reduce the rate of preoperative misdiagnosis.关键词
胆囊肿瘤/胆囊乳头状腺癌/误诊/漏诊/胆囊息肉/胆结石/胆囊切除术,腹腔镜/病理学检查Key words
Gallbladder neoplasms/Papillary adenocarcinoma of the gallbladder/Misdiagnosis/Missed diagnosis/Gallbladder polyps/Cholelithiasis/Cholecystectomy,laparoscopic/Pathological examination分类
临床医学
