意外胆囊癌60例临床诊治分析

Clinic analysis of unexpected gallbladder carcinoma:report of 60 cases

目的总结胆囊切除术中、术后胆囊癌发生的临床特点,探究其误诊原因、预防措施及改善预后的对策。方法回顾性分析西安交通大学医学院第一附属医院、西安航天总医院及解放军第451医院2002年1月～2011年1月期间开腹及腹腔镜胆囊切除术中或术后发现的60例意外胆囊癌患者的临床资料及预后情况。结果术中发现24例,术后发现36例。Nevin分期:Ⅰ期8例,Ⅱ期14例,Ⅲ期19例,Ⅳ期12例,Ⅴ期7例。其中20例仅行胆囊切除术或胆囊切除+胆道探查术,术后1、2、3年累积生存率为65.0%、45.0%、20.0%;40例术中快速病理确诊或术后病理回报再次手术行胆囊癌根治术或扩大根治术,术后1、2、3年累积生存率分别为82.5%、62.5%、45.7%。结论对存在胆囊癌高危因素的患者,应建议患者尽早行胆囊切除术;术前仔细分析各项检查结果并做好充分的准备,切除胆囊后术中仔细剖检胆囊;发现胆囊三角区解剖结构紊乱及邻近区域肿大淋巴结者应高度重视;怀疑胆囊癌时应术中对标本行冰冻切片检查以明确诊断;确诊胆囊癌后,应早期行根治性切除。

Objective To analyze clinical characters of unexpected gallbladder carcinoma（UGC）in cholecystectomy and to discuss the methods of avoiding loss of diagnosis and improving the treatment.Methods From Jan 2002 to Jan 2011,performed a retrospective analysis of 60 patients who were treated in First Affiliated Hospital of Xi＇an Jiaotong University College of Medicine,Xi＇an Aerospace General Hospital and 451 Hospital of PLA for UGC during or after cholecystectomy.Results Among the 60 cases of UGC,24 cases were diagnosed intraoperatively by checking the gallbladder sample and forzen section examination,and 36 cases were diagnosed postoperatively by general pathological examination.According to Nevin classification,8 cases were stage Ⅰ,14 cases were stage Ⅱ,19 cases were stage Ⅲ,12 cases were stage Ⅳ,5 cases were stage Ⅴ,in which 20 cases were only performed cholecystectomy and the 1-,2-,3-year overall cumulative survival rates were 65.0%,45.0%,20.0% respectively.Radical cholecystectomy was performed on the rests of 40 cases and the 1-,2-,3-year overall cumulative survival rate were 82.5%,62.5%,45.7% respectively.Conclusion For high risk population,cholecystectomy should be performed early.Analyzing preoperative clinical data of patients prudently,palpating the specimen carefully,and frozen section examination for any suspicion of cancer seem to be helpful for the diagnosis of UGC.Standard radical resection should be performed immediately once the diagnosis is confirmed.