冰冻切片检查对诊断术中意外胆囊癌的意义

Frozen sections examination for diagnosis of unexpected gallbladder neoplasm during cholecystectomy in acute cholecystitis

目的探讨胆囊切除术治疗急性胆囊炎的过程中,冰冻切片检查对于诊断意外胆囊癌的临床意义。方法回顾性分析2012年12月至2017年12月郑州大学第一附属医院1386例急性胆囊炎患者行胆囊切除术的临床资料。结果1386例急性胆囊炎患者中发现19例合并胆囊癌。通过大体观察,术中可辨别出9例胆囊癌,其中包括2例T2期和2例T3期胆囊癌,但却漏诊了 10例胆囊癌。同时,在通过组织病理学确诊为胆囊癌的10例病例中,3例原位癌和1例Tla期胆囊癌没有被冰冻切片检查发现。冰冻切片诊断的灵敏度是60%,特异性是100%.结论在急性胆囊炎行胆囊切除术的过程中,外科医生大体观察诊断意外胆囊癌的准确性较低。冰冻切片检查诊断晚期胆囊癌的准确性很高,因此,提倡对胆囊切除术的标本进行选择性的冰冻切片检查。

Objective To explore the clinical significance of intraoperative frozen sections for the diagnosis of unexpected gallbladder neoplasm during cholecystectomy for acute cholecystitis. Methods We retrospectively analyzed the clinical data of acute cholecystitis patients who underwent cholecystectomy at the First Affiliated Hospital of Zhengzhou University, from Dec 2012 to Dec 2017. Results In the 1 386 acute cholecystitis patients, 19 patients were found to have concurrent gallbladder neoplasm. Surgeons accurately recognized 9 gallbladder neoplasms by general observation alone, including 2 T2 and 2 T3 gallbladder neoplasms, but missed 10 gallbladder neoplasms. At the same time, we found that 3 Tis and 1 T1 a gallbladder neoplasms were missed by frozen sections from 10 gallbladder neoplasms diagnosed by definitive histopathological examination. The sensitivity of frozen sections diagnosis was 60% and the specificity was 100%. Conclusions During cholecystectomy for acute cholecystitis, the accuracy of surgeonsz diagnosis with general observation in unexpected gallbladder neoplasm is poor. The accuracy of frozen sections to diagnose advanced gallbladder neoplasm is high, so we advocate frozen sections of every cholecystectomy sample in acute cholecystitis patients.