腹腔镜胆囊切除术意外胆囊癌的诊断与治疗：附23例报告

Diagnosis and treatment of incidental gallbladder cancer after laparoscopic cholecystectomy: a report of 23 cases

目的:探讨腹腔镜胆囊切除术(LC)意外胆囊癌的诊断和治疗。方法:回顾性分析1998年1月—2007年1月收治的23例意外胆囊癌患者的临床资料。结果:15例术中快速冷冻病理证实为胆囊癌,其中13例中转开腹行胆囊癌根治术;8例术后病理证实,其中7例行二次开腹手术。全组术后5年生存率为78.3%,患者预后与其临床分期密切相关。结论:意外胆囊癌多为早期胆囊癌,高危病例应重视术中快速病理检查及标本检查;T1b-T2期宜扩大根治,晚期患者视情况行根治性手术或姑息治疗。

Objective： To discuss the diagnosis and treatment of incidental gallbladder cancer （IGC） during laparoscopic cholecystectomy. Methods： The clinical data of 23 patients with IGC admitted to our hospital from January 1998 through January 2007 were retrospectively analyzed. Results： Fifteen patients were identified as gallbladder cancer by intraoperative frozen-section examination, 13 of them were converted to open radical resection; 8 patients were diagnosed by postoperative pathology, 7 of whom underwent a secondary open surgery. The postoperative 5-year survival rate of the entire group was 78.3%, and the prognosis oflGC was closely related to the TNM stages. Conclusion： Incidental gallbladder cancer is often in early stage, attention should be paid to the specimen examination and intraoperative fast frozen-section in the high-risk patients. The extended radical operation is preferred for patients with T1b-T2 tumors, and for the advanced stage cases, whether to perform radical operation or palliative procedures may depend on the individual＇s condition.