腹腔镜手术中意外胆囊癌的临床处理分析

Analysis of clinical management for unsuspected gallbladder carcinomas discovered during laparoscopy

目的:探讨在腹腔镜胆囊切除术(LC)中意外发现胆囊癌的治疗方法。方法:对14例LC时意外发现的胆囊癌患者的临床资料进行回顾性分析。结果:4例NevinⅠ、Ⅱ期患者行单纯LC,2例Ⅲ期和3例Ⅳ期患者行LC中转开腹+局部淋巴结清扫术+肝脏楔形切除术,5例Ⅴ期患者行胆囊姑息性切除术。全组意外胆囊癌的发生率为0.06%。结论:Ⅰ期的意外胆囊癌行LC可达到根治目的,Ⅱ期行胆囊切除+肝脏部分切除+术后化疗,Ⅲ、Ⅳ期需行胆囊癌根治术,Ⅴ期根据情况行胆囊切除或姑息手术。

Objective： To assess the surgical approaches for unsuspected gallbladder carcinomas （UGC） discovered during laparoscopic cholecystectomy （LC）. Methods： Based on clinical data, retrospective analysis were carried out for 14 patients with UGC discovered during LC. Results： 4 patients with tumors of Nevin＇s stage Ⅰ or stage Ⅱ underwent simple LC alone; 2 patients with tumors of stage Ⅲ and 3 patienrs with tumors of stage Ⅳ were converted to laparotomy, and performed wedge excision of gallbladder bed and regional lymphadenectomy; 5 patients with tumors of stage Ⅴ were employed for palliative cholecystectomy. In this series, the incidence of UGC was 0.06%. Conclusions： UGC of Stage Ⅰ may be cured after simple LC, while these of stage Ⅱ should receive cholecystectomy and partial liver resection with postoperative chemitherapy. UGC of stage Ⅲ and Ⅳ should be referred for radical operation, and those of stage Ⅴ can be treated with cholecystectomy or other palliative surgical procedures.