腹腔镜胆囊切除术中意外胆囊癌12例诊治分析

The diagnosis and treatment of unexpected gallbladder carcinoma in laparoscopic cholecystectomy:with an analysis of 12 cases

目的：探讨腹腔镜胆囊切除术（Lc）中意外胆囊癌（unexpected gallbladder carcinoma，UGC）的处理措施。方法：回顾分析本院955例LC术中遇到的12例（1．26％）UGC的临床资料。结果：随诊3—36个月，平均18个月。迄今全部存活。5例阻1、5例PT2、1例PT3（中转开腹）随访至今未发现癌复发及转移。1例PT2因拒绝根治术，现出现肝多发转移。1例PT4因腹腔种植转移，无法根治，故仅部分切除胆囊（胆囊粘连重），以解决急性胆囊炎问题，现有腹水、恶液质表现。所有病例均未见脐部戳孔处肿瘤种植转移。结论：LC术中应常规切开胆囊标本，必要时送术中冰冻。阻1单纯切除胆囊已足够；PT2要额外楔形切除肝组织及区域淋巴结；PT3中转开腹，行根治手术或姑息手术。

Objective：To explore the strategy for management of unexpected galllbladder carcinoma （UCG） in laparoscopic cholecystectomy （LC）. Methods：A retrospective study was performed on 12 patients with UGC discovered during laparoscopic cholecysteetomy in 955 patients. Results：The mean follow-up time is 18 months （3-36 months） ,and all of the 12 cases is alive up to now. No recurrence of metastasis was detected in 5 cases of PT1,5 cases of PT2 and 1 case of 1-3 （ converted to laparotomy）. 1 case of PT2 who rejected radical operation appears multiple liver aversion now. And another 1 case of PT4 with abdominal implantation, only received partial resection in order to solve acute cholecystitis has abdominal dropsy now. No tumor implantation was found in umbilical puncture hole in all cases. Conclusions ： Dissecting the gallbladder wall for inspection and palpating the mucosa is useful for the diagnosis of incidental gallbladder carlinoma, and when necessary, histopathologic examination should be performed. LC for PT1 gallbladder cancer needs no additional treatment, however, wedge resection of liver bed tissue and district lymphaden for PT2 patients is recommended, Conversion to the open procedure and radical operation or palliative operation for PT3 is prefered.