腹腔镜胆囊切除意外胆囊癌的处理

Unsuspected gallbladder cancer management during or after laparoscopic cholecystectomy

目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)遇意外胆囊癌(unsuspected gallbladder carcinoma,UGC)的原因及应对策略.方法:回顾性分析本院1989-06/2008-11行LC患者6429例中遇到的术中及术后诊断为UGC的27例(0.4%)临床资料.结果:所有27例胆囊癌病例中,在LC术中诊断17例,LC术后诊断有10例.pT1期、pT2期和pT3期各9例.患者的1、3和5年存活率分别为74.1%、63%和59.3%.pT1期的5年存活率为100%,pT2期的5年存活率为66.7%,pT3期的5年存活率为0.0%,差异有统计学意义(P<0.05).结论:UGC患者的存活与肿瘤分期相关,pT1期胆囊癌,行LC即可.怀疑有胆囊癌在可能情况下及时行冰冻病理检查,对于确诊pT1期以外的UGC应该尽早开腹行胆囊癌根治术,并采取必要措施防止肿瘤种植和转移.

AIM： To explore the effectiveness of surgeons in determining the unsuspected gallbladder carcinoma （UGC） at laparoscopic cholecystectomy （LC） and the management of UGC. METHODS： A total of 6429 patients with gallbladder disease were included in this study who underwent LC during June, 1989 and November, 2008. Patients with UGC were reviewed retrospectively to assess preoperative diagnosis, intraoperative findings and outcomes. RESULTS： Of the total patients, 27 in 6429 （0.4%） were histopathologically diagnosed as UGC during （17） or after （10） LC. The tumor stages ofthe 27 diagnosed were pT1 （9）, pT2 （9）, and pT3 （91）, each with 9 cases. The survival rates of all the UCG patients in one-year, three-year and five-year were 74.1%, 63% and 59.3%, respectively. The five-year survival rates of pT1 stage, pT2 stage and pT3 stage were 100%, 66.7% and 0.0%, respectively, not significantly affected by whether the patients had been diagnosed with UGC during or after LC （P 〈 0.05）. CONCLUSION： The survival rate from UGC is associated with tumor stage and it is confirmed that a carefully performed LC is adequate treatment for pT1 stage cancer. If a suspicious lesion is found, intraoperative frozen section is performed for pathological examination. However, radical operation is recommended for T2 patients and effective measures should be taken to avoid tumor implant and metastasis.