腹腔镜胆囊手术中意外胆囊癌的诊治对策

Diagnosis and Treatment of Unexpected Gallbladder Carcinoma During Laparoscopic Cholecystectomy

目的探讨腹腔镜手术意外胆囊癌的临床特点及治疗方法。方法回顾性分析1997年9月～2015年9月我院4620例腹腔镜胆囊切除（laparoscopic cholecystectomy,LC）手术中意外胆囊癌12例的临床资料。1例术中冰冻病理诊断胆囊癌NevinⅢ期,中转开腹行胆囊癌根治术;11例术后病理诊断胆囊癌,NevinⅠ期1例和Ⅱ期1例未补充手术,Ⅲ期9例中5例拒绝手术,4例术后10～18 d（平均14 d）开腹行胆囊癌根治术。结果 5例NevinⅢ期LC后拒绝手术者失访。Ⅰ、Ⅱ期各1例LC术后随访63个月和6个月无复发,Ⅲ期行胆囊癌根治术5例中,2例分别术后8、10个月因腹腔广泛转移,死于恶病质,3例术后10、28、32个月胆囊癌肝转移死亡。结论腹腔镜胆囊手术时应高度警惕意外胆囊癌的发生,应及时行合适的补充治疗。

Objective To explore clinical characteristics and treatment for unexpected gallbladder carcinoma during laparoscopic surgery. Methods A retrospective analysis was made on clinical data of 12 cases of unexpected gallbladder carcinoma out of 4620 cases of laparoscopic cholecystectorny （LC） in our hospital from September 1997 to September 2015. Intraoperative frozen pathological diagnosis showed gallbladder cancer Nevin stage Ⅲ in 1 case, and a conversion to open surgery of gallbladder cancer was conducted. The remaining Ⅱ cases of gallbladder carcinoma were diagnosed by pathology after surgery. One case of Nevin stage I and 1 case of stage Ⅱ were not surgically treated. Of the other 9 cases of Nevin stage Ⅲ , there were 5 patients who refused surgery and 4 patients received open radical resection of gallbladder cancer at 10 - 18 d （mean, 14 d） postoperatively. Results The 5 cases of Nevin stage Ⅲ who refused open radical surgery were lost to follow-up. Two cases of stage Ⅰ and Ⅱ were followed up for 63 months and 6 months after LC without recurrence. Of the 5 cases of stage Ⅲ undergoing open radical surgery, 2 eases dead at 8 and 10 months postoperatively because of abdominal extensive metastasis and cachexia, and 3 eases dead at 10, 28, and 32 months postoperatively because of gallbladder carcinoma liver transfer. Conclusions The occurrence of unexpected gallbladder cancer should be taken into consideration during laparoscopic cholecystectomy. Timely and appropriate complementary therapy should be given.