开展腹腔镜胆囊癌根治术的启示与思考

Enlightenment and reflection of laparoscopic radical cholecystectomy

胆囊癌是一种早期诊断困难、恶性程度高、预后差的胆道恶性肿瘤,根治性切除术是改善患者预后最有效的手段。随着微创设备的更新及外科医师经验的积累,腹腔镜手术在多种消化道恶性肿瘤疾病的治疗中已取得令人满意的效果,但是在胆囊癌治疗的应用中仍存在争议,主要原因是缺乏改善生存预后的可靠证据。腹腔镜手术可以使部分早期胆囊癌患者围术期及生存获益。对于进展期胆囊癌患者,尽管对切除范围仍未达成共识,但通过分期腹腔镜手术可以让患者避免不必要的扩大切除。胆囊癌的微创化进程需要通过高质量的诊断与治疗流程规范化推动,唯有如此才能得到有实际意义的临床证据指导最佳临床实践。

Gallbladder cancer is a biliary malignant disease with difficulty in early diagnosis,high malignancy and poor prognosis.Radical resection is the most effective approach to improve the prognosis of patients.With the update of minimally invasive devices and the accumulation of surgeon experience,laparoscopic surgery has achieved satisfactory results in the treatment of malignant tumors of the digestive tract,but there is still controversy in its application in gallbladder cancer treatment,mainly due to lack of reliable evidence for improved survival outcomes.The current studies indicated that laparoscopic surgery could benefit some patients with early gallbladder cancer in perioperative period and survival.For advanced gallbladder cancer,although there is still no consensus on the resection extent,laparoscopic staging can prevent patients from unnecessary expanded resection.The minimally invasive process of radical cholecystectomy needs to be promoted through a high-quality diagnosis and treatment process.Only in this way can there be practical clinical evidence to guide the best clinical practice.