意外胆囊癌在腹腔镜切除术中或术后的处理对策

Approach of unexpected gallbladder cancer in laparoscopic surgery or after operation

目的探讨意外胆囊癌在腹腔镜切除术中或术后的处理方法。方法选择35例意外在腹腔镜切除术中或术后发现胆囊癌的患者,探讨其手术方法,术后随访结果。结果所有患者住院时间6~13天,平均住院时间8.9±2.9天。术后辅助化疗的患者共10例,病理分期包括6例T1b期患者和3例T2期患者、1例T3期患者。31例Tis、T1a、T1b患者中除1例失访外,其余患者在随访期间内均存活,未发现癌复发及转移。T2期的患者3例,分别于术后13、16、20个月后死亡,平均存活时间17个月。T3期患者1例,于术后2个月死亡。结论 Tis和T1a期意外胆囊癌直接行腹腔镜胆囊切除术即可,T2、T3期应追加行根治性手术,T1b期的患者仍有待继续研究。

Objective To investigate approach of unexpected gallbladder cancer in laparoscopic surgery or after operation. Methods 35 cases of accidental gallbladder cancer in laparoscopic surgery or after surgery were collected. Their surgical methods were discussed and postoperative results were followed- up. Results In all patients,hospitalized time was from 6 to 13 days,the average hospital stay was 8. 9 ± 2. 9 days.Adjuvant chemotherapy in patients was taken in a total of 10 cases,including 6 cases in pathological stage T1 b,3 cases in T2,and 1 case in T3.In 31 patients with Tis,T1 a,T1b,except 1 patient had lost in follow- up,the remaining patients were alive during the period of follow- up and we found no cancer recurrence and metastasis. Three patients in T2 period died,respectively,after 13,16,20 months,with the average survival time of 17 months. One patient in T3 period,died 2 months after surgery. Conclusion In patients with unexpected gallbladder cancer in Tis and T1 a,we can directly use laparoscopic cholecystectomy. In T2 and T3,we should append radical surgery. In T1 b,study is still to be continued.