腹腔镜胆囊切除治疗意外胆囊癌与胆囊癌根治术的临床分析

A clinical study on unsuspected gallbladder carcinoma identified during or following laparoscopic cholecystectomy and immediate or two stage radical resection of the gallbladder carcinoma

目的探讨腹腔镜胆囊切除术（LC）治疗意外胆囊癌与再次行胆囊癌根治术对预后的影响。方法7例LC术意外胆囊癌（12期）患者再次接受胆囊癌根治术（开腹或腔镜下），与同期进行的开腹一期根治手术的14例胆囊癌（12期）患者加以对比，采用Kaplan—Meier法分析两组的生存率。结果LC组和开腹组术后的1、3、5年生存率分别为100％、67％、67％和92％、84％、60％。两组生存时间的差异无统计学意义（x^2=0．015，P=0．901）。3例浸润深度为胆囊黏膜层的T1a期胆囊癌经LC治疗后均生存6年以上。3例腹腔镜胆囊癌根治术的患者术后随访6～12个月，均为无瘤生存。结论在注意避免术中胆汁溢出、应用标本取出袋等无瘤保护措施得当的情况下。及时行胆囊癌根治术，先期的LC不影响12期胆囊癌的预后，而对于T1a期胆囊癌仅行LC即可获得满意的长期生存。

Objective To evaluate the clinical result of radical resection of gallbladder carcinoma in patients with unsuspected gallbladder carcinoma while undergoing laparoscopic cholecystectomy （LC） and the prognosis. Methods A retrospective analysis was conducted on 7 patients with gallbladder carcinoma discovered during or after LC who underwent further radical cholecystectomy because of tumor invasion of the whole layer without extension beyond serosa （T2 stage）, in comparison with those 14 patients of T2 stage gallbladder carcinoma who underwent primary stage of open radical cholecystectomy. Kaplan-Meier method was used to analyze the survival rate between LC group （ n = 7） and open surgery group （ n = 14）. Results The 1,3 and 5-year survival rates for LC group were 100% ,67% and 67% respectively, and the rates for open surgery group were 92% ,84% and 60% respectively. There was no significant difference between the survival time of these two groups （ x^2 = 0. 015, P = 0. 901 ）. Three patients with postoperative pathology proved gallbladder carcinoma invading mucosa （Tla stage） in the primary LC attempt have survived more than 6 yeats. Three other patients with gallbladder carcinoma who underwent laparoscopic further radical cholecystectomy have survived for 6 - 12 months without recurrence. Conclusions Under the condition of adequate tumor-free preventive method such as prevention of bile spillage, using retrieval bag to extract the gallbladder, and radical cholecystectomy were conducted in time, LC did not affect the prognosis of T2 stage gallbladder carcinoma. The long-term survival rates of patients with T1 a stage gallbladder carcinoma who had undergone LC onlv are relatively good.