胆囊癌诊断和治疗指南(2015版)

Guideline for the diagnosis and treatment of gallbladder carcinoma (2015 edition)

  • 摘要: 为规范胆囊癌的诊断和治疗,中华医学会外科学分会胆道外科学组基于循证医学原则,从胆囊癌的主要流行病学危险因素及病因、胆囊癌的TNM分期、病理学类型、诊断依据、术前和术中评估、治疗原则与方法、随访等方面进行了全面论证。强调术前应根据多排螺旋CT和(或)MRI等影像学检查结合肝功能状态评估对胆囊癌的分期及可切除性做出判断;术中需结合快速冷冻切片病理学检查、淋巴结活组织检查(13a组、16
    组)再次进行胆囊癌TNM分期,以指导治疗方式的选择;并建立基于T分期选择肝切除范围、基于淋巴结活组织检查选择淋巴结清扫范围,基于胆囊管切缘病理学选择肝外胆管切除范围的胆囊癌根治性手术原则。

     

    Abstract: To standardize the procedures of diagnosis and treatment of gallbladder carcinoma (GBC), the Biliary Surgery Group of Surgery Branch of Chinese Medical Association (CMA) worked out a comprehensive guideline for the diagnosis and treatment of GBC. The guideline is based on the principles of evidencebased medicine, detailing the epidemiological factors, etiologies, pathological assessment, TNM staging, diagnostic considerations, preoperative and intraoperative evaluation, treatment of GBC and followup. The guideline emphasizes the preoperative judgement on the staging and resectability of GBC in accordance with multislice spiral computed tomography (MSCT), magnetic resonance imaging (MRI) and 3dimensional reconstruction plus with liver function evaluation. It also provides guidance for the GBC treatment according to findings of intraoperative ultrasound, quick freezing sections and lymph node biopsy (13a, 16). The principle of radical resection of GBC was conducted by selecting the extents of liver resection, lymph nodes dissection and extrahepatic bile duct resection respectively based on T staging, lymph node biopsy and pathological examination of resection margins of cystic duct.

     

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