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【Objective】 To analyze the clinical characteristics of patients with primary carcinoma of the gallbladder (PGC) who underwent radical intent resection in our center in the last decade and the therapeutic effects of the operation. 【Methods】 A single-institution database of The First Affiliated Hospital of Xi'an Jiaotong University from January 2008 to December 2017 was queried for patients with PGC who had received surgical treatment. The data were studied retrospectively to assess the trend of total admission, radical resection rate, prognosis and clinicopathological characteristics of PGC in the last decade. 【Results】 A total of 2 159 patients with PGC were treated in our institution from 2008 to 2017. Of them, 1072 were surgically treated and 503 underwent radical intent resection. In the past 5 years (2013-2017), the radical resection rate was 26.5% (319 cases of the operation), which was significantly higher than that in 2008-2012 (19.2%) (P<0.001). The overall survival time of the patients who underwent radical resection was 32 months, and the 1-, 3-, and 5-year survival rate was 68.9%, 48.4% and 41.6%, respectively. Compared with the data of 2008-2012, the proportion of the patients with preoperative jaundice decreased in the past 5 years (7.8% vs. 14.7%, P<0.05), that of the patients who underwent D2 lymphadenectomy (74.0% vs. 26.1%, P<0.001) increased significantly (P<0.001), the total number of lymph nodes obtained from the dissection (8.07±5.18 vs. 5.89±3.14, P<0.001) increased significantly (95.6% vs. 89.7%, P<0.05), and the proportion of R0 resection (95.6%) increased significantly (P<0.05). 【Conclusion】 The diagnosis and treatment of radical intent resection of PGC in our hospital have changed significantly in the last decade, mainly reflected in the extension of lymphadenectomy, increase in R0 resection rate and decrease in patients with preoperative jaundice.
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Objective To investigate the relationship between helicobacter pylor (Hp) and primary carcinoma of the gallbladder (PCG), providing a theoretical basis for the treatment of PCG.Methods Mucosa and bile of gallbladder samples were collected from 18 patients with PCG (PCG group), 40 patients with chronic cholecystitis or cholelithiasis (CC group), and 20 patients with no PCG and CC (control group). 16S rDNA-based polymerase chain reaction (PCR) followed by DNA sequence analysis of the obtained PCR fragments was performed. A developed search for Hp was also carried out by PCR. Five genes specific for Hp were amplified. Results In the PCG group, 81% samples of mucosa and bile were positive for Helicobacter-specific 16S rRNA gene. The positive rate in PCG group was significantly higher than those of the CC group (50%) and the control group (20%).Of the 16S rDNA sequence of Helicobacter pylori positive samples of mucosa and bile, 52% of samples were positive in cagA, 86% were positive in 26 KDa, 48% were positive in ureA separately. The vacA and rps4 genes were never detected in any of the samples of mucosa and bile. At least one gene was positive in 93% of samples of musca and bile. The sequencing showed more than 99% homology of Helicobacter 16S rRNA in PCG and Hp groups. Conclusion A higher infection rate is present in bile and gallbladder mucosa from patients with PCG. Hp in the biliary system may be one of the risk factors for occurrence of PCG.
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Primary carcinoma of the gallbladder(PCG) is the most common malignant tumor in biliary system and its morbility has been rising year by year in our country.Because there is no specific clinical manifestation,patients diagnosed finally as PCG have mostly been in intermediate or advanced stage,thus losing the chance of radical resection of gallbladder carcinoma and having a poor prognosis.In this article we analyze the high risk factors,diagnosis of imageology,study of molecular biology,therapeutic progression and existent problems about PCG,by reviewing the related literature about diagnosis and treatment of PCG and the clinical data of 945 patients with PCG who were treated in our hospital in recent fifty years.We realize that early diagnosis of PCG is still difficult nowadays,it is very significant for secondary prevention of PCG to continue to carry out the foundamental and clinical study of PCG.Combined therapy that mainly includes surgical operation remains cardinal therapeutic management,and gene therapy has gradually developed to become a new therapy and displays favourable prospect of application.
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Primary adenosquamous carcinoma of the gallbladder is an extremely uncommon neoplasm which accounts for approximately 2% of carcinomas of the gallbladder. According to a recent extensive review of carcinomas of the gallbladder, the dismal outlook for this carcinoma still prevails in spite of recent advances in diagnostic and surgical techniques because of late diagnosis and ineffectual treatment. A sixty-one-year-old female patient visited the Department of Internal Medicine due to postprandial epigastric discomfort. Abdominal sonography, abdominal computed tomography (CT), and endoscopic retrograde cholangiopancreatography (ERCP) were performed. We treated the patient with a cholecystectomy and chemotherapy with FAM. However, five months after discharge, the patient revisited, complaining of epigastric discomfort. We performed abdominal CT and gastrofiberscopy. The result was a recurrence of the cancer in the bed of the gallbladder and in the liver. However, the patient and her family did not want more treatment for the metastase of the cancer. We experienced one case of an adenosquamous-cell carcinoma of the gallbladder, and we report this rare cancer with a review of the literature.