腹腔镜胆囊切除术术中或术后意外胆囊癌11例临床分析

Diagnosis and prognosis of unsuspected gallbladder carcinoma during or after laparoscopic cholecystectomy

目的探讨影响腹腔镜胆囊切除术（LC）术中或术后意外胆囊癌（UGC）的诊断和预后的重要因素。方法回顾分析2009年1月至2014年6月因LC而发现UGC的临床资料。结果11例UGC中，Tis期3例，平均年龄58．4岁，病史13．3年，手术方式为LC，冰冻病理切片诊断准确率为66．7％，术后生存时间46．8个月；T1bN0M0期2例，平均年龄60．8岁，病史12．4g，采用根治性胆囊切除术，术后生存时间42．5个月；T2N0M0期2例，平均年龄62．5岁，病史15．5年，采用根治性胆囊切除术，冰冻病理和石蜡包埋病理诊断率均为100％，术后生存时间37．3个月；T2N1M0期1例，年龄65岁，病史13年，采用根治眭胆囊切除术，冰冻病理和石蜡包埋病理诊断率均为100％，术后生存时间32．4个月；T4NtM1期3例，平均年龄64．9岁，病史15年，2例采用根治性胆囊切除术，1例采用姑息性胆囊切除术，冰冻病理和石蜡包埋病理诊断率均为100％，术后生存时间24．5个月。除T1bN0M0期中1例需要二次手术，其他均无二次手术。结论术中快速冰冻病理诊断和术后石蜡包埋病理诊断相结合，才能提高UGC诊断率。对UGC病人应根据病理分期，选择单纯胆囊切除或根治性胆囊切除术。

Objective To explore the major influencing factors for the diagnosis and prognosis of unsuspected gallbladder carcinoma （UGC） during or after laparoscopic cholecystectomy （LC）. Methods From January 2009 to June 2014, the clinical data of 11 cases of UGC during or after LC were analyzed. Results For 3 cases of stage Tis, the average age was 58. 4 years with a medical history of 13. 3 years. And operative mode was LC, the diagnostic accuracy of frozen pathological section was 66. 7% and the postoperative survival was 46. 8 months; for 2 cases of T2N0M0, the average age was 60. 8 years with a medical history of 12. 4 years. Operative mode was radical cholecystectomy and the postoperative survival was 42. 5 months; for 2 cases of T2 No Mo, the average age was 62. 5 years with a medical history of 15.5 years. Operative mode was radical cholecystectomy. The diagnostic accuracies of frozen and paraffin-embedded pathologies were both 100%. The postoperative survival was 37. 3 months; for 1 case of T2N1Mo, the average age was 65 years with a medical history of 13 years. Operative mode was radical cholecystectomy. The diagnostic accuracies of frozen and paraffin-embed- ded pathologies were both 100%. The postoperative survival was 32. 4 months; for 3 cases of T4 N1 M0 , the average age was 64. 9 years with a medical history of 15 years. Operative mode was radical cholecystectomy （n = 2） or palliative cholecystectomy （n = 1）. The diagnostic accuracies of frozen and paraffin-embedded pathologies were both 100%. The postoperative survival was 24. 5 months. Reoperation was required for only 1 case of T1 bNo M0. Conclusions A combination of fast frozen pathological diagnosis during operation and paraffin embedded pathological diagnosis after operation may boost the diagnostic rate of UGC. Simple or radical cholecystectomy may be selected according to different pathological stages.