32例腹腔镜胆囊切除术意外胆囊癌的临床诊治

Clinical Diagnosis and Treatment of 32 Cases with Unexpected Gallbladder Carcinoma after Laparoscopic Cholecystectomy

目的：分析腹腔镜胆囊切除术中或术后发现意外胆囊癌的，临床特点，探讨其诊治措施。方法：回顾性分析2008年1月～2012年12月在我院行腹腔镜胆囊切除术治疗发现的意外胆囊癌患者共计32例的临床资料和随访结果。结果：24例患者经术中快速冷冻病理证实，其中12例中转开腹行胆囊癌根治术；8例患者经术后病理证实，6例行二次开腹手术。NevinI期4例，NevinII期20例，NevinIII期5例，NevinIV期2例，NevinV期1例。32例患者均顺利出院，住院时间6-24d，平均住院时间（13．8±8．1）d。32例中有30例获得随访，2例失访，随访时间2～49个月，平均（24．2±14．6）个月。生存23例，死亡7例，分别死于术后2、3、5、12、14、18和32个月。术后有5例患者出现并发症，2例胆囊积液，2例切口感染和1例胆瘘，经对症治疗后好转。结论：加强对胆囊癌的警惕与认识，腹腔镜胆囊切除术中或术后发现意外胆囊癌后应根据具体情况，选择最佳手术方式治疗，提高根治切除率，延长患者生存期。

Objective： To analyze the clinical characteristics of 32 cases with unexpected gallbladder cancer after laparoscopic cholecystectomy and to further explore more effective diagnosis and treatment methods. Methods： A retrospective analysis of 32 cases with unexpected gallbladder cancer after laparoscopic cholecystectomy were conducted from Jan. 2008 to Dec. 2012. Results： 24 patients were identified as gallbladder cancer by intraoperative frozen-section examination, and 12 of them were converted to laparotomy; 8 patients were proved by postoperative pathology, 7 of them underwent a secondary laparotomy. Nevin stage： Nevin I in four cases, Nevin II in 20 cases, Nevin III in 5 cases, Nevin IV in 2 cases and Nevin V in 1 cases. 32 patients leaved from hospital, with the hospitalization time 6-24 d, with an average time of （13.8 ±8.1） d. 30 cases of 32 were followed up for 2 to 49 months, with an average time of（24.2 ± 14.6） months, 2 patients were lost during the process of follow up. 23 patients survived, and 7 died of postoperative for 2, 3, 5, 12, 14, 18 and 32 months, respectively. 5 patients occurred complications after surgery, two cases of gallbladder hydrops, two cases of wound infection and one case of biliary fistula, and all were improved after symptomatic treatment. Conclusion： It is necessary to strengthen vigilance and awareness of unexpected gallbladder. According to the specific circumstances, we choose the best surgical approach that can improve the radical resection rate and prolong the survival time.