16例意外胆囊癌的诊治分析

Aggressive Diagnosis and Treatment for 16 Cases of Unexpected Gallbladder Carcinoma

目的探讨意外胆囊癌的诊断和治疗。方法回顾性分析2006年1月至2012年12月胆囊切除术中或术后病理发现的原发性胆囊癌16例临床病例资料。结果术前诊断2例为胆囊息肉,14例为胆囊炎胆囊结石;常规开腹胆囊切除术(OC)2例,腹腔镜胆囊切除术(LC)14例;术后病理Nevin分期,Ⅰ期2例,Ⅱ期7例,Ⅲ期4例,Ⅳ期3例。;2例术中怀疑,经术中快速病理证实,1例单纯胆囊切除,1例术中再次行部分肝切除+肝十二指肠韧带周围淋巴结清扫术;术后病理证实14例,3例单纯胆囊切除,未再次手术;5例再次行肝十二指肠韧带周围淋巴结清扫术;3例再次手术行部分肝切除+肝十二指肠韧带周围淋巴结清扫术,3例放弃再次手术;随访时间至2013年4月,已有12例死亡,6例仍存活,最长者已存活40个月,最短者在术后3个月内死亡,4例存活期超过36个月。结论术前应重视胆囊癌的高危因素和增强对胆囊癌的诊断意识,以减少意外胆囊癌的发生;Nevin分期Ⅰ期和Ⅱ期侵犯胆囊粘膜患者可行LC,Ⅱ期侵犯肌层及其以上分期患者需再行开腹胆囊癌根治术。

Objective To explore the diagnosis and treatment of unexpected gallbladder carcinoma（UGC）. Methods We analyzed retrospectively the clinical data of 16 cases of UGC incidently found after cholecystectomy from January 2006 to December 2012. Results Of these patients,the preoperative diagnosis was gallbladder polyps in 2 cases, and gallstone cholecystitis in 14 cases. Open cholecystectomy （OC） was performed for 2 cases, laparoscopic cholecystectomy （LC） was performed for 14 cases. Postoperative Nevin staging： stage Ⅰ , 2 cases; stage Ⅱ ,7 cases; stage Ⅲ, 4 cases;stageⅣ ,3 cases. 2 cases were suspected and confirmed gallbladder carcinoma by frozen-section examination, 1 case was not operated again, the other one was operated again with partially hepatectomy and lymph node dissection of hepatoduodenal ligament. 14 cases were confirmed gallbladder carcinoma by postoperative pathology, simple cholecystectomy was performed for 3 cases, lymph node dissection of hepatoduodenal ligament was performed for 5 cases, the partially hepatectomy and lymph node dissection of hepatoduodenal ligament was performed for 3 cases,3 cases gave up secondary operation. By the end of April 2013 of the follow-up period,6 patients were still alive,the survival time was over 36 months in g cases, the shortest survival was 3 months,the longest survival was 40 months. Conclusion We should think highly of risk factors of gallbladder carcinoma and reinforce diagnostic consciousness of gallbladder carcinoma for reduction of unexpected gallbladder carcinoma preoperatively. LC is sufficient for patients with Nevin stage Ⅰ and Ⅱ （metastasis were located in mucous membrane of gallbladder）, radical resection after cholecystectomy is required for patients with stageⅡ（ metastasis were located in submucous layer of gallbladder） or more advanced stage.