腹腔镜胆囊切除术与意外胆囊癌

Laparoscopic cholecystectomy and gallbladder carcinoma

目的:探讨腹腔镜胆囊切除术后意外发现胆囊癌的处理方法。方法:对1997～2001年14例腹腔镜胆囊切除术中或术后意外发现的胆囊癌进行临床病理分析。结果:14例意外胆囊癌中男2例,女12例。平均年龄66.1岁。术前诊断1例为胆囊息肉,余13例为胆囊炎胆囊结石(92.8%)。有7例中转开腹手术,1例因发现转移仅在腹腔镜下行腹壁肿块活检术,6例完成腹腔镜胆囊切除术。术后病理TNM分期:0期1例,Ⅰ期4例,Ⅱ期3例,Ⅲ期3例,Ⅳb期3例。至随访截止时,已有9人死亡,5人仍存活,存活期超过36个月者有4人,最长者已存活68月。结论:腹腔镜胆囊切除术不适用于胆囊癌病人。提倡腹腔镜术中对可疑病灶进行冰冻切片病理检查。对胆囊癌侵犯深度超过肌层者应中转开腹或术后再次开腹行根治性手术。

Objective To explore the strategy for management of unexpected gallbladder carcinoma after laparoscopic cholecystectomy. Method A retrospective clinicopathologic study was performed on 14 patients with unexpected gallbladder carcinoma discovered during or afer laparoscopic cholecystectomy from 1997 to 2001. Results There were 12 women and 2 men, with a mean age of 65.4 years. Of these patients ,the preoperative diagnosis was gallbladder polyps in 1 case, and gallstone cholecystitis in 13 cases（92.8%）. Six patients underwent complete laparoscopic cholecystectomy, 7 patients were converted to an open procedure and the other one received only tumor biopsy under laparoscopy. Postoperative TNM staging： stage O, 1 case; stage Ⅰ, 4 cases; stage Ⅱ, 3 cases; stage Ⅲ, 3 cases; and stage Ⅳb, 3 cases. By the end of 80 monthes of the follow-up period, 5 patients were still alive; the survival time was over 36 months in 4 cases and the longest survival was 68 months. Conclusions Laparoscopic cholecystectomy is not suitable for gallbladder carcinoma. Frozen-section examination is recommended for suspected lesions during LC. For cases with invasion deeper than the muscular layer, a conversion to open surgery or a secondary radical surgery is indicated in order to achieve better prognosis.