腹腔镜下意外胆囊癌的治疗和临床分析

Treatment and clinical analysis of unsuspected gallbladder carcinoma during and after LC

目的探讨意外胆囊癌的临床病理特点及治疗措施。方法回顾性分析本院24例LC下意外胆囊癌(UGC组)的临床资料,并与同期收治的其他胆囊癌(GC组)对比。结果UGC组早期(ⅠA期)比例(25.0%,6/24)明显高于GC组(5.0%,2/40)(P=0.02);晚期(Ⅲ、Ⅳ)(16.7%,4/24)比例明显低于GC组(77.5%,31/40)(P<0.01);手术根治切除率(83.3%,20/24)明显高于GC组(32.6%,29/89)(P<0.01);UGC组的总体1、3、5年生存率(83%,46%,21%)及平均生存期和中位生存期(37±7,27月)均明显高于GC组(36%,19%,6%;21±6,6月)(P<0.01)结论UGC早期病例相对高及晚期病例相对少,根治性切除率相对高,预后相对好;诊断应重视高危因素和重视术中快速病检;除Tis及T1a期外,其他分期一律应行再次手术争取根治性切除。

Objective To investigate the elinicopathological features and therapeutic methods of unexpected gallbladder carcinoma. Methods The clinical data of 24 cases of unexpected gallbladder carcinoma （ UGC group） treated in our hospital by LC from January 2000 to December 2008 was analysised retrospectively and was compared with that of the other gallbladder carcinoma of our hospital in the same times. Results The incidence of early stage UGC （ I A） （25.0% ,6/24 ） was significandy higher than that of GC（5.0% ,2/40） （ P =0. 02） while that of advanced stage UGC （Ⅲ ＋ Ⅳ ） （ 16.7% ,4/24） was significantly lower than that of GC（77. 5% ,31/40） （P 〈 0. 01 ）. The incidence of Radical resection in UGC （83. 3% ,20/24 ）was signifi- candy higher than that of GC （32. 6% ,29/89） （P 〈0. 01 ）. the overall 1-year,3-year,5-year survival （83%, 46% ,21% ）for UGC ,mean and media survival（37 ± 7,27 month） was significantly higher than that of GC （ 32.6% ,29/89） （ P 〈 0.01 ）. Conclusions There are different characteristics between UGC and GC, such as incidence o early stage or advanced stage and incidence of Radical resection. Prognosis of UGC is better than GC relatively; We should pay close attention to the risk factors of UGC and frozen section examination during operation ; Except for Tis and T1a , all cases diagnosed turn to OC in time or make second radical excision early afterLC.