重视意外胆囊癌的规范诊疗

徐畅; 金诚; 刘厚宝

doi:10.12449/JCH251205

重视意外胆囊癌的规范诊疗

DOI: 10.12449/JCH251205

复旦大学附属中山医院普外胆道外科，复旦大学胆道疾病研究所，上海 200030

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：徐畅负责文章框架撰写及文章内容修改；金诚负责文章初稿撰写及文献查阅；刘厚宝负责指导文章方向及最后定稿。

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通信作者:
刘厚宝， liuhbao@163.com （ORCID： 0000-0003-0608-6522）

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出版历程
- 收稿日期: 2025-10-23
- 录用日期: 2025-11-05
- 出版日期: 2025-12-25

The standardized diagnosis and treatment of incidental gallbladder carcinoma should be taken seriously

Department of Biliary Surgery，Institute of Biliary Tract Diseases，Zhongshan Hospital，Fudan University，Shanghai 200030，China

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Corresponding author: LIU Houbao， liuhbao@163.com （ORCID： 0000-0003-0608-6522）

摘要

摘要: 意外胆囊癌是指因胆囊良性疾病行胆囊切除术后，病理检查偶然发现的胆囊癌，其术前漏诊率高、分期跨度大、治疗决策复杂，是胆道肿瘤领域的重要挑战。本文结合当前证据，系统梳理意外胆囊癌的流行病学、发病机制、诊断现状与治疗策略，剖析当前诊疗瓶颈，并从精准早诊、分子分型指导的个体化治疗、多学科协作模式构建等方面展望未来方向，以期为临床实践与研究提供参考。
- 胆囊肿瘤 /
- 胆囊切除术 /
- 诊断 /
- 治疗学
Abstract: Incidental gallbladder cancer （IGBC） refers to gallbladder cancer discovered incidentally during pathological examination after cholecystectomy for benign gallbladder diseases， and characterized by a high rate of missed diagnosis before surgery， wide staging variability， and complex treatment decision-making， IGBC poses a significant challenge in biliary tract oncology. With reference to existing evidence， this article systematically reviews the epidemiology， pathogenesis， diagnostic status， and treatment strategies of IGBC， analyzes existing bottlenecks in diagnosis and treatment， and proposes the future prospects from the aspects of precise early diagnosis， individualized treatment guided by molecular subtyping， and establishment of multidisciplinary collaboration models， in order to provide a reference for clinical practice and research.
- Gallbladder Neoplasms /
- Cholecystectomy /
- Diagnosis /
- Therapeutics

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表 1 诊疗转变建议

Table 1. Recommendations for changes in diagnosis and treatment

建议	具体内容
构建GBC风险评估与筛查体系	1.将胆囊结石、胆囊息肉等良性疾病的定期随访纳入常规管理，制订基于年龄、性别、肥胖程度、结石大小等因素的风险评分系统。 2.开发适用于基层医疗机构的GBC筛查工具，如便携式miRNA检测设备，提高早期发现率。 3.研发新型诊断技术，如基于人工智能的影像分析系统，提高早期诊断率。 4.建立全国性IGBC登记系统，收集临床数据，为制订循证指南提供依据。
制订IGBC规范化诊疗指南	1.由权威机构牵头，制订基于循证医学的IGBC诊疗指南，明确不同分期的手术指征、辅助治疗方案。 2.建立IGBC的病理诊断标准，规范冰冻病理与常规病理的诊断流程。 3.深入探索IGBC的分子机制，开发特异性靶点和生物标志物。 4.制订IGBC术后随访方案，明确影像学检查与肿瘤标志物检测的频率和指标。
推动多学科协作诊疗模式	1.在大型三甲医院设立GBC诊疗中心，整合肝胆外科、肿瘤内科、病理科、影像科等资源。 2.建立远程会诊平台，将IGBC规范化诊疗模式推广至基层医院。 3.开展多学科团队培训，提升各学科对IGBC的认识和协作能力。 4.开展针对IGBC的临床试验，特别是针对“经典亚型”的靶向治疗和免疫治疗研究。
优化医疗政策与资源配置	1.将IGBC的早期筛查纳入医保报销范围，提高患者筛查依从性。 2.加大对IGBC研究的投入，设立专项科研基金。 3.通过政策引导，促进医疗资源向IGBC高发地区倾斜。

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