腹腔镜胆囊切除术中意外胆囊癌的诊治

Diagnosis and treatment of unexpected gallbladder carcinoma in laparoscopic cholecystectomy

目的 探讨腹腔镜辅助下术中或术后意外发现的早期胆囊癌行根治术的可行性.方法 回顾性分析2007年1月至2013年8月在我科腹腔镜下胆囊切除术中或术后病理发现的34例原发性胆囊癌患者的临床资料.其中29例为术中快速病理确诊为胆囊癌,5例为术后病理确诊为Ⅰ期、Ⅱ期胆囊癌.结果 34例患者均成功完成了标准的胆囊癌根治术,其中20例Ⅰ期、Ⅱ期和Ⅲ期中肿瘤仅浸透浆膜,或肿瘤侵犯肝的深度不足2 cm的患者行腹腔镜下单纯胆囊切除术或根治性/扩大根治性胆囊切除术,9例中转开腹行根治性/扩大根治性胆囊切除术或联合肝段/叶切除的胆囊根治性切除术.5例单纯胆囊切除术后病理确诊为胆囊癌的患者再次行腹腔镜下胆囊癌根治性/扩大根治性手术.结论 胆囊癌Ⅰ期、Ⅱ期和Ⅲ期中肿瘤仅浸透浆膜,或肿瘤侵犯肝的深度不足2 cm的患者均应行根治性或扩大根治性胆囊切除术.行腹腔镜辅助下根治性或扩大根治性胆囊切除术短期治疗效果满意,5年生存率两者差异无统计学意义.且具有更低的疼痛不适率,更短的住院时间,可以达到与开腹同样的手术效果,达到了根治的要求.

Objective To explore the feasibility of radical cholecystectomy for early gallbladder car cinoma found during or after laparoscopic cholecystectomy.Methods A retrospective study was conducted on patients who received laparoscopic cholecystectomy between January 2007 to August 2013 and were diagnosed to have gallbladder cancer during or after the operation.There were 34 patients.In 29 patients intraoperative frozen section diagnosed gallbladder carcinoma.In 5 patients postoperative histopathological study diagnosed stage Ⅰ or Ⅱ gallbladder carcinoma.Results Surgery was conducted successfully on these 34 patients.In 20 patients with stage Ⅰ,Ⅱ and Ⅲ,the tumor had invaded the serosa,or into the liver with a depth of less than 2 cm,laparoscopic cholecystectomy alone or radical/extended radical cholecystectomy were carried out.In 9 patients,the laparoscopic surgery was converted to open surgery and these patients underwent cholecystectomy with resection of the adjacent liver segments/sections.In 5 patients who were diagnosed to have gallbladder carcinoma after laparoscopic cholecystectomy,they were re-operated with laparoscopic radical cholecystectomy.Conclusions Stage Ⅰ,Ⅱ and Ⅲ gallbladder carcinoma with tumor invasion into serosa,or patients with tumor invasion into the liver with a depth of less than 2 cm should undergo radical or extended radical cholecystectomy.Laparoscopic assisted radical or extended radical cholecystectomy could achieve the same operation as with open surgery but with better short-term results.There were less pain,smaller incisions,better scars and shorter hospitalization stay.