腹腔镜胆囊切除术中意外胆囊癌16例诊治分析

Unsuspected gallbladder carcinoma during laparoscopic cholecystectomy:An analysis of 16 cases

目的 探讨腹腔镜胆囊切除术 (laparoscopiccholecystectomy ,LC)中遇到意外胆囊癌 (unsuspectedgallbladdercarcinoma ,UGC)的原因及防治措施。 方法 回顾性分析本院 6 0 31例LC术中遇到的 16例 ( 0 2 6 % )UGC的临床资料。 结果 术中发现胆囊癌 (gallbladdercarcinoma ,GC) 9例 ,另 7例经术后病理证实。全组中位生存期为 2 0 3月。原发肿瘤为T2 以上的 15例中 ,确诊后行开腹手术者 10例 ,未开腹手术者 5例 ,术后生存时间分别为 ( 19 9± 4 9)月及 ( 9 8± 2 8)月 ;行根治及扩大根治术者 9例 ,未行根治术者 6例 ,术后生存时间分别为 ( 2 1 6± 5 3)月及 ( 7 8± 2 6 )月。 结论 行LC前应加强对GC的警惕与认识 ,术中应常规检查胆囊标本 ,有怀疑者及时行冰冻切片检查。UGC确诊后宜尽早开腹行根治性和扩大根治性切除术 。

Objective To explore the causation as well as the prevention and treatment of unsuspected gallbladder carcinoma (UGC) during laparoscopic cholecystectomy (LC). Methods Clinical data of 16 cases of UGC encountered during 6 031 cases of LC (0.26%) in this hospital were retrospectively reviewed. Results Out of the 16 cases of UGC, 9 were diagnosed intraoperatively and the other 7 were identified by histopathologic examination after surgery. The median survival time was 20.3 months. Of the 15 cases with primary tumor over T 2 stage: open operation was performed in 10 cases and the other 5 cases didn’t undergo open surgery after the diagnosis was clarified, the postoperative survival time being (19.9±4.9) and (9.8±2.8) months, respectively; 9 cases underwent radical or aggressive radical cholecystectomy and 6 didn’t undergo redical resection, the postoperative survival time being (21.6±5.3) and (7.8±2.6) months, respectively. Conclusions Recognition and precautions about gallbladder carcinoma should be strengthened before LC. The resected gallbladder should be routinely examined and frozen-section examination should be applied promptly if there have any suspicions of malignancy. Once the UGC is diagnosed, radical or aggressive radical resection should be adopted as early as possible, and necessary measures should be taken to prevent implantation and metastasis of carcinoma.