Медицинская литература. Новинки

 

 

 

 

 

 

Ошибки диагностики рака желчного пузыря

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Цель исследования: определить причины ошибок диагностики рака желчного пузыря (РЖП). Материал и методы. Проанализированы результаты обследования и лечения 34 больных РЖП. Результаты. РЖП диагностирован у большинства больных (92,8%) при стадии Т4, распространение на печень имелось у 78,9%, метастазы в печени - у 32,1%, метастазы в лимфоузлах - у 39,2% больных. Чувствительность и специфичность в диагностике РЖП при УЗИ составили 73,7 и 16,7%, при РКТ - 64,3 и 33,3%, при МРТ - 69,2 и 0%, при СА 19-9 - 71,4 и 66,7%, при хирургической оценке - 94,1 и 50% соответственно. Отсутствие истинно отрицательных результатов при МРТ не позволило рассчитать специфичность. Низкая специфичность методов обусловлена большим числом ошибочных результатов - у 10 (29,4%) больных. Ложноположительные заключения связаны с выраженными воспалительными изменениями в желчном пузыре с перихолециститом и перигепатитом. Ложноотрицательные результаты связаны с быстрым распространением РЖП на печень, которое принимается за первичный рак печени с вовлечением желчного пузыря. Выводы. Диагностика РЖП является трудной задачей, даже при запущенных стадиях. Тем не менее требуется комплексная диагностика с применением УЗИ, РКТ МРТ, определением уровня СА 19-9 и выполнением пункционной биопсии.

Ключевые слова:
рак желчного пузыря, диагностика, новообразования желчного пузыря, gallbladder cancer, diagnosis, neoplasms of the gallbladder, gall bladder polyps

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Mistakes in the Diagnosis of Gallbladder Cancer

Objective. To determine the causes of misdiagnosis of gallbladder cancer (GBC). Materials and Methods. The results of examination and treatment of 34 patients GBC. Results. GBC was diagnosed in the majority of patients (92,8%) with stage T4, had spread to the liver from 78.9%, the liver metastases in 32.1%, the metastases in the lymph nodes in 39.2%. Sensitivity and specificity in the diagnosis GBC were 73.7% and 16.7% for ultrasound; 64.3% and 33.3% for X-ray CT; 69.2% and 0% for MRI; 71.4 % and 66.7% for CA -199; 94.1 % and 50% for the surgical evaluation. Lack of true positive MRI results are not possible to calculate the specificity. Low specificity of the methods due to the large number of false positives results - in (29.4%) patients. False positive results associated with inflammatory changes in the gallbladder and surrounding liver. False-negative results associated with the rapid spread of GBC on the liver, which is taken as primary liver cancer involving the gallbladder. Conclusion. Diagnosis GBC is a difficult task, even in advanced stages. Nevertheless, requires a comprehensive diagnosis using ultrasound, X-ray CT, MRI, determination of the level of CA 19-9 and biopsy

Keywords:
рак желчного пузыря, диагностика, новообразования желчного пузыря, gallbladder cancer, diagnosis, neoplasms of the gallbladder, gall bladder polyps