腹腔镜胆囊切除术相关的意外胆囊癌15例诊治分析

The analysis of 15 cases with laparoscopic cholecystectomy-related unsuspected gallbladder cancer

目的探讨腹腔镜胆囊切除术（LC）相关的意外胆囊癌（UGC）的诊治方法。方法对在1995年1月至2008年12月4520例Lc术中、术后发现的15例UGC患者的临床资料进行回顾性分析。结果15例UGC术中发现7例，术后发现8例，所有病例术后进行病理检查及Nevin分期，Ⅰ期4例，Ⅱ期7例，Ⅲ期3例，Ⅳ期1例。Ⅰ期仅行LC；Ⅱ、Ⅲ期行胆囊癌根治术；Ⅳ期行扩大根治术。15例患者术后随访6个月至5年，3例5年内死亡，12例5年随访时仍存活，5年生存率为80．O％。结论LC相关的UGC以早期癌为主，术中对高危患者及可疑者做快速病理检查有助于UGC的发现。NevinI期病例行LC可达到根治目的，NevinⅡ-Ⅳ期病例需开腹行根治术。

Objective To explore the diagnosis and treatment of unsuspected gallbladder cancer （UGC） related with laparoscopic cholecystectomy （LC）. Methods From January 1995 to Dece m bet 2008,4520 cases of LC were performed, UGC was discovered in 15 cases. Clinical data of the 15 cases were analyzed retrospectively. Results Among the 15 cases of UGC, 7 were discovered intraoperatively, and 8 were diagnosed postoperatively. Postoperative pathological examination showed Nevin stage Ⅰ in 4 cases, stage Ⅱ in 7 cases, stage Ⅲ in 3 cases, stage Ⅳ in 1 case. LC was carried out in the patients of Nevin stage Ⅰ. Radical resection of gallbladder cancer was performed on the patients at stage Ⅲ and stage In. One patient at stage received extended radical resection. The patients were followed up from 6 months to 5 years,during the period 3 cases were died and 12 cases were still alive, the 5-year survival rate was 80.0%. Conclusions Most of LC-related UGC cases are early cancer. Frozen section examination should be performed for high-risk groups and suspicious persons, which contributes to the discovery of UGC. LC can achieve the radical purpose of Nevin stage Ⅰ patients, Nevin stage Ⅱ -Ⅳrequires open radical operation.