胆囊保留性手术与意外胆囊癌

Gallbladder-preserving operation and unsuspected gallbladder carcinoma

目的探讨内镜微创保胆手术意外发现胆囊癌的处理方法。方法对2004年1月～2009年2月5例内镜微创保胆手术术中发现的胆囊癌患者进行临床分析。结果 5例意外胆囊癌患者中。术前诊断慢性结石性胆囊炎3例、慢性结石性胆囊炎合并胆囊息肉1例、单纯胆囊息肉1例。术后病理分期:NevinⅡ期1例、NevinⅢ期3例、NevinⅤ期1例。至随访截止,2人死亡,3人存活,最长者已26个月,仍存活。结论具有胆囊癌高危因素的患者应行开腹胆囊切除术,提倡内镜微创保胆术中对可疑病灶进行冷冻切片病理学检查,对意外胆囊癌患者建议施行根治性胆囊切除术。

[Objective]To explore the management of unsuspected gallbladder carcinoma during the gallbladder-preserving operation.[Methods]A retrospective study was performed on 5 patients with unsuspected gallbladder carcinoma discovered during the gallbladder-preserving operation from 2004 to 2009. [Results]Of 5 patients, the preoperative diagnosis was chronic calculous cholecystitis in 3 cases, chronic calculous cholecystitis following gallbladder polyps in 1 case, and gallbladder polyps in 1 case. Postoperative nevin staging： stage Ⅱ, 1 case; stage Ⅲ, 3 case; Stage V, 1 case. By the end of 60 months of the follow-up period, 2 patients died, and 3 patients were still alive. The longest survival was 26 months. [Conclusions]Patients with high dangerous factor involving gallbladder carcinoma should undergo open cholecystectomy. For patients with unsuspected gallbladder carcinoma should receive radical cholecystectomy.