腹腔镜术中意外胆囊癌的诊断与处理策略

Diagnosis and therapeutic strategies of incidental gallbladder cancer in laporoscopic cholecystectomy

意外胆囊癌是指术前诊断为良性病变,但是在胆囊单纯切除术中或术后病理诊断的胆囊癌,在腹腔镜胆囊切除中这种情况时有发生。提高术前影像诊断准确率可以减少意外胆囊癌发生率,准确的术中快速冰冻病理切片检查能够有效避免二次手术。病理诊断T分期为T1a及Tis期的意外胆囊癌患者,单纯胆囊切除术即可达到根治要求,无需二次手术。而T1b及更高T分期的意外胆囊癌患者,需要接受二次手术。二次手术的手术范围参照胆囊根治性切除的要求,也可以根据T分期来决定肝脏的切除范围和淋巴结清扫范围。

Incidental gallbladder cancer refers to pathologically confirmed gallbladder cancer during or after cholecystectomy.More accurate preoperative imaging diagnosis could effectively improve the diagnosis rate of gallbladder cancer,and intraoperative rapid frozen pathological examination helps to avoid the re-operation.For patients with T1a and Tis staging accidental gallbladder cancer,cholecystectomy could achieve radical effect.For patients with T1b or more late staging gallbladder cancer,radical re-operation is very important,and it is necessary to determine the extent of liver resection and lymph node dissection according to the staging of gallbladder cancer.