胆囊切除术后意外性胆囊癌的治疗

ANALYSIS OF THE DIAGNOSIS AND TREATMENT OF UNEXPECTED GALLBLADDER CANCER OF POSTCHOLECYSTECTOMY

目的探讨胆囊切除术后意外性胆囊癌的二次手术方式以及对预后的影响。方法对我院自1995年1月“2005年1月因诊断为胆囊良性疾病而行胆囊切除，因术后病理证实为胆囊癌而二次行胆囊癌根治术17例患者进行回顾性分析。结果本组17例均因胆囊良性疾病行开放性单纯胆囊切除手术，术后病理证实为胆囊癌，术后病理：胆囊腺癌13例，鳞癌3例，鳞腺癌1例。初次手术Nevin病理分期：I期2例，Ⅱ期4例，Ⅲ期8例，Ⅳ期3例。二次手术发现淋巴结转移11例，3例有肝转移和远处转移，胆囊床转移2例，胆管转移1例，二次手术Nevin病理分期：I期2例，Ⅱ期3例，Ⅲ期1例，Ⅳ期8例，V期3例，术后随访半年到5年，6例死亡，存活11例。结论术中对于胆囊标本的仔细检查可以减少意外性胆囊癌的发生率。二期根治性手术对于部分意外性胆囊癌是有益的。

Objective To invest5igate the secondary operation methods and the effects on the prognosis of unexpected gallbladder cancer of postcholecystectomy. Methods The clinical data for 17 patients who were suffered from unexpected gallbladder cancer of postcholecystectomy and underwent radical escision from Jan, 1995 to Jan. 2005 in our hospital were analyzed retrospectinvely. Results All the 17 cases were performed open operation because of innocuous gallbladder dieases, and carcinoma of gallbladder was confirmed by postoperative pathology. Among 17 cases were adenocarcinoma of gallbladder, 3 cases were squamous carcinoma, 1 case was squamous adcnocarcinoma,The first postoperative pathology showed that 2 cases were on the stage of Nevin I ,4 on Nevin Ⅱ,8 on Nevin Ⅲ,3 on Nevin Ⅳ ,The second operation chose the improved method of Glcnn excision of carcinoma of gallbladdcr,on the second operation, 11 cases were with lymphatic metastasis ,2 cases with gallbladder bed metastasis, 1 case with bileduct metastasis, and 3 cases had liver or distant organ metastasis,2 cases were on the stage of Nevin Ⅰ ,3 on Nevin Ⅱ ,1 on Nevin Ⅲ,8 on Nevin Ⅳ ,3 on Nevin V. During the period of postoperative follow-up visit,6 cases were dead, 11 cases were still survived. Conclusion To check minutely the spcimen of gallbladder can reduce the incidence rate of unexected gallbladder cancer of postcholecystectomy. Simple cholecystectomy is enough to some of the patients while two-period surgery is helpful to the others.