腹腔镜胆囊切除手术后意外胆囊癌的临床分析

Clinical analysis of unexpected gallbladder carcinoma after laparoscopic cholecystectomy

目的:探讨腹腔镜胆囊切除手术(LC)后意外胆囊癌的诊断、处理及预后。方法:回顾分析2001～2004年间术后意外胆囊癌病例26例,其中发现于LC术后10例,发现于开腹胆囊切除手术(OC)术后16例;结合临床资料和随访结果进行分析。结果:LC术后意外胆囊癌中,1例为pT2病人,行开腹胆囊癌根治手术;1例为pT2病人,术后4月发现切口肿瘤种植。全组中位生存期17.5个月,各病理分期生存期在pT1者为(28.3±10.3)个月,pT2者为(14.8±11.1)个月,pT3者为(6.0±1.4)个月,与OC组比较无统计学差异。两组pT2病人中,行根治手术者生存期与未行根治手术者相比,无统计学差异。结论:LC术中怀疑为胆囊癌者,应行冰冻切片检查,并采取预防切口肿瘤种植的相应措施。发现意外胆囊癌后的根治手术效果有待进一步观察。

Objective To investigate the diagnosis, treatment and prognosis of unexpected gallbladder carcinoma（UGC） after laparoscopic cholecystectomy （LC）. Methods Clinical and followed-up data of 26 cases of UGC undergoing LC （10 cases） or open cholecystectomy （16 cases） from 2001-2004 were retrospectively analyzed. Results In the LC group, 1 pT2 case underwent radical resection; port-site metastasis was found in another pT2 case 4 months after operation.The median survival time of the LC group was 17.5 months： that of pT1 cases being （28.3±10.3） months, pT2 cases （14.8±11.1） months and pT3 cases （6.0±1.4） months; the figures were quite close to those of the OC group, In pT2 cases of both the LC or OC groups, the survival time after radical resection was quite close to one another, Conclusions Frozen section examination and protection to port-site metastasis should be applied if there is any suspicion of malignancy, The merit of radical resection in UGC should be further elucidated.