意外早期胆囊癌的手术治疗与预后分析

目的 探讨意外发现的早期胆囊癌的治疗方法与预后.方法 回顾性总结1995年7月至2005年7月我院收治的24例意外早期胆囊癌临床病理资料,对其治疗方法及影响预后的因素进行分析.结果 24例术中快速冰冻切片或术后病理切片证实为早期胆囊癌(Nevin Ⅰ~Ⅱ期).7例于术中施行了标准的根治术,10例术后确诊再行根治,7例行单纯胆囊切除术.多因素分析表明,组织学分级、Nevin分期及手术方式是影响预后的独立因素;再次行根治手术组生存率与即刻行根治手术组比较无统计学差异,单纯胆囊切除术组与胆囊癌根治术组患者的生存率差异有统计学意义.结论 早期胆囊癌术前诊断困难,术中对可疑者做快速冰冻切片检查有助于发现早期胆囊癌;一旦确诊即予施行根治术,术后病理明确者亦应再行根治手术.     

意外胆囊癌:附15例报告

目的 探讨意外胆囊癌的诊断和处理方法 .方法 回顾性分析近10年来2所医院15例意外胆囊癌患者的临床资料.结果 开腹手术发现8例,腹腔镜胆囊切除术发现7例,其中Nevin Ⅰ期3例,Ⅱ期9例,Ⅲ期2例,Ⅳ期1例.其中10例首次手术中施行根治术,3例术后确诊再行根治术,另2例Ⅰ期患者行单纯胆囊切除术后病理诊断为癌,未再行手术.Ⅰ、Ⅱ期均随访2年以上仍存活,Ⅲ期病例均术后2年内复发死亡,Ⅳ期半年内死亡.结论 早期胆囊癌术前诊断困难,重视其高危因素,术中对可疑病例行快速冰冻切片检查有助于诊断;根治性手术为胆囊癌最有效治疗方法.     

意外胆囊癌一期手术的临床分析

目的探讨意外胆囊癌的术中确诊和一期手术的方法和重要性。方法回顾性总结2001年6月至2016年6月发现的意外胆囊癌53例,其中2010年3月后有32例,全部一期完成了手术。结果全组53例,强调了一期手术处理的理念后,有32例全部一期完成了手术。结论通过术中剖检胆囊、快速冰冻病理,及时术中诊断意外胆囊癌、一期手术,可有效避免二次手术。     

腹腔镜胆囊切除术意外胆囊癌的诊断与治疗:附23例报告

目的:探讨腹腔镜胆囊切除术(LC)意外胆囊癌的诊断和治疗。方法:回顾性分析1998年1月—2007年1月收治的23例意外胆囊癌患者的临床资料。结果:15例术中快速冷冻病理证实为胆囊癌,其中13例中转开腹行胆囊癌根治术;8例术后病理证实,其中7例行二次开腹手术。全组术后5年生存率为78.3%,患者预后与其临床分期密切相关。结论:意外胆囊癌多为早期胆囊癌,高危病例应重视术中快速病理检查及标本检查;T1b-T2期宜扩大根治,晚期患者视情况行根治性手术或姑息治疗。     

腹腔镜胆囊切除术意外胆囊癌58例诊治分析

[摘 要] 目的 探讨腹腔镜胆囊切除术（LC）意外胆囊癌的诊断与治疗。方法 回顾性分析2007 年5 月至2017 年5 月武警安徽省总队医院收治的意外胆囊癌患者58 例临床资料。结果 LC术中发现24 例,术后发现34例;TNM分期T1b 12例,T2 34例,T3 6例,T4 6例。24例术中快速冰冻病理检查证实为胆囊癌,其中22例中转开腹行胆囊癌根治术;34例术后病理证实,其中24例行二次开腹手术。非根治组：12例,仅行单纯胆囊切除术,术后1、2、3年累积生存率分别为65.0%、42.5%、18.0%。根治组：46例,行胆囊癌根治术,术后1、2、3年累积生存率分别为82.5%、62.5%、45.7%,两组生存曲线比较差异有统计学意义（P＜0.05）。结论 胆囊癌患者预后与手术方式、临床分期密切相关,对存在胆囊癌高危因素的患者,建议尽早行胆囊切除术。意外胆囊癌多为早期胆囊癌,应重视术中检查及病理检查,T1b～T3 期宜行根治手术,晚期患者应根据病情行姑息手术。     

腹腔镜胆囊手术中意外胆囊癌的诊治对策

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。     

19例意外胆囊癌的诊断和治疗

目的:探讨意外胆囊癌的临床特点及治疗措施.方法:对我院19例胆囊切除术中、术后发现的意外胆囊癌的诊治情况进行回顾性分析.结果:早期胆囊癌患者胆囊切除加淋巴结清除术10例,平均生存时间18.7个月;扩大根治术患者4例,平均生存时间为12.3个月;姑息性手术患者5例,生存时间均未超过6个月.结论:意外胆囊癌术中快速病理切片检查是诊断的关键,确诊后首选根治性切除术,具体治疗措施根据Nevin病理分期和术中8超检查决定.     

腹腔镜胆囊切除中意外胆囊癌的处理(附16例报道)

目的评价腹腔镜胆囊切除术(LC)中意外胆囊癌的诊断、处理及预后。方法对我院2000年1月至2010年1月期间5 832例行LC中16例意外胆囊癌患者的临床资料进行回顾性分析。结果 16例意外胆囊癌中7例行LC,9例行开腹胆囊癌根治术。术后病理TNM分期:Ⅰ期10例,Ⅱ期4例,Ⅲ期2例。16例患者术后随访6～60个月,平均23.3个月。随访期内死亡15例。9例接受胆囊癌根治手术的患者术后1、3、5年生存分别为8/9、4/9及1/9,而7例仅行LC的患者术后1年生存为4/7,无生存超过2.5年者。结论 LC术中应高度警惕意外胆囊癌的发生,意外胆囊癌多为早期,应及时中转开腹行胆囊癌根治术,仅行单纯的LC治疗效果欠佳。     

腹腔镜胆囊切除术术中或术后意外胆囊癌的处理对策

目的：探讨腹腔镜胆囊切除术（ LC）意外胆囊癌（ UGC）的处理对策。方法回顾性分析我院2005年1月至2012年10月3355例LC,术中和术后发现的8例UGC的临床资料。结果8例UGC,占同期LC的0.24％（8/3355）,术中发现4例,术后发现4例。根据TNM分期（第7版,2009）,其中pTis 2例,pT1b 1例,pT23例,pT42例。pTis及pT1b患者仅行LC,术后均长期存活,最长已超过5年;pT2中2例中转开腹行胆囊癌根治术,术后存活已达半年以上;1例因术后发现,患者拒绝再次手术,术后半年复发;pT4中1例因累及肝脏及肝外胆管,拒绝进一步手术,仅行LC,术后3个月出现戳孔种植,术后6个月死于腹腔广泛转移;1例中转开腹行姑息胆囊切除并取活检,3个月后死于多脏器衰竭。无围手术期死亡患者。结论重视胆囊癌高危因素、完善的术前检查、术中对胆囊标本仔细剖检和快速冰冻检查以及确诊后必要的中转开腹是提高胆囊癌早期确诊率、改善胆囊癌预后的关键。术中应切实采取相关措施降低肿瘤细胞腹腔转移与切口种植的发生率。     

50例意外胆囊癌的临床分析及处理

目的总结腹腔镜胆囊切除术及开腹手术术后意外胆囊癌的临床特点,评价二次手术的效果。方法回顾性分析2006年1月至2011年1月间经腹腔镜胆囊切除术及开腹手术发现的50例意外胆囊癌的临床资料及随访情况。结果50例均为肿瘤高危人群,18例由术中冰冻切片检查后确诊,32例术后确诊。TNM分期I期5例。Ⅱ期6例,Ⅲ期22例,Ⅳ期17例。二次术后中位生存期22个月,I期、Ⅱ期、Ⅲ期及Ⅳ期的中位生存期分别为33个月、24个月、17个月及6个月。结论胆囊癌症状隐匿,术前仔细分析临床资料,术中对可疑标本行术中快速冰冻切片检查能有效避免意外胆囊癌的漏诊。     

意外胆囊癌的临床处理与预后分析

目的 总结意外胆囊癌的临床病理特点、诊断与治疗方案的选择,分析与预后有关的因素,指导意外胆囊癌的规范化治疗.方法 回顾性分析北京协和医院1999年1月至2009年10月收住院治疗的27例意外胆囊癌的临床资料,应用Kaplan-Meier法对比单纯胆囊切除术组、胆囊癌根治术组以及NevinⅠ、Ⅱ期与Ⅲ、Ⅳ、Ⅴ期患者的累积生存率,对意外胆囊癌的治疗方法与预后进行分析.结果 27例患者以胆囊良性疾病的术前诊断行胆囊切除术,术前诊断以急慢性胆囊炎、胆囊结石和胆囊息肉为主.术后病理学检查证实为胆囊癌,其中低分化腺癌9例,中分化腺癌9例,高分化腺癌4例,腺瘤癌变5例.按Nevin分期,Ⅰ期2例,Ⅱ期5例,Ⅲ期8例,Ⅳ期5例,Ⅴ期7例.胆囊癌根治术组患者累积生存率好于单纯胆囊切除术组(x2=4.450,P=0.035);Nevin Ⅰ、Ⅱ期患者预后显著优于Ⅲ、Ⅳ、Ⅴ期(x2=6.825,P=0.014).结论 意外胆囊癌临床表现缺乏特异性,容易导致误诊,术中快速病理切片检查是明确诊断的重要方法,确诊后首选根治性切除术.     

87例意外胆囊癌多中心诊疗分析

目的 分析多中心意外胆囊癌（IGBC）病例治疗现状,探讨IGBC的诊断与治疗要点。方法回顾性分析2013年1月至2020年6月上海市浦东新区6家医院收治的87例IGBC患者临床资料,男27例（31.03%）,女60例（68.97%）;年龄34～89岁,平均68岁。术前诊断为胆囊结石伴胆囊炎67例,其中合并胆总管结石9例;胆囊息肉4例;胆囊腺肌症5例;胆囊结石合并胆囊息肉8例;慢性胆囊炎2例。术前87例患者均行B超检查;26例行CT检查,其中6例发现胆囊壁局部或不规则增厚;术前行肿瘤标志物检测52例,CA199升高7例（67～238 kU/L）。结果 同期6家医院行腹腔镜胆囊切除术（LC）16 411例,IGBC占比0.53%;同期胆囊癌根治术219例,IGBC占比39.73%。87例IGBC中,急诊LC 25例（28.74%）,择期LC62例（71.26%）;术中冰冻病理发现IGBC 70例,术后常规病理发现IGBC 17例;行胆囊癌根治术65例,未行根治术22例。术后病理检查,Tis期15例,T1期20例,T2期28例,T3期22例,T4期2例。45例获得随访,随访时间3～96个月,中位时间26个月。T分期越早,生存期越长（P=0.01039）,根治性手术明显改善患者的生存期（P=0.00423）。结论 意外胆囊癌应从胆囊良性疾病的规范化诊治角度入手防治,才能减少其发生;根治手术能提高意外胆囊癌患者术后的生存期。     

黄色肉芽肿性胆囊炎的诊治(附22例报告)

目的　探讨黄色肉芽肿性胆囊炎 (XGC)的诊断和治疗。方法　对我院 1 990年 2月 -2 0 0 0年 3月间收治的 2 2例XGC作回顾性分析。结果　XGC占同期胆囊标本的 1 .4% (2 2 1 5 2 3 )。临床表现与一般胆囊炎类似 ,B超示胆囊壁不规则隆起或增厚 7例 ,CT检查 5例怀疑为胆囊癌 ,肿瘤标志物检查 1例铁蛋白 (SF)轻度升高 ;伴黄疸 4例中 1例合并胆总管结石 ,1例合并胰头癌。术前全部误诊。术中冰冻切片检查 1 0例 ,4例确诊为XGC ,其余为术后病理诊断。行胆囊大部切除术 2例 ,胆囊切除加肝边缘不规则切除术 2例 ,其余行单纯胆囊切除。全部治愈。结论　XGC是一种特殊类型的胆囊炎 ,临床表现不典型 ,易与胆囊癌相混淆 ,术前难于诊断。组织病理学检查是确诊的重要手段。胆囊切除是常用的术式 ,不能排除胆囊癌时应扩大手术范围。本病预后良好     

Gallbladder cancer: the role of laparoscopy and radical resection

OBJECTIVES: We assess how laparoscopy has altered the presentation of patients with gallbladder cancer and determine whether radical resection in patients with gallbladder cancer is beneficial. SUMMARY BACKGROUND DATA: The widespread adoption of laparoscopic cholecystectomy has led to an increased frequency of incidentally discovered gallbladder carcinoma. Little data exist to guide surgeons in the optimum management of patients with gallbladder cancer, particularly with respect to the potential advantages of radical resection. METHODS: Records of 107 patients with gallbladder cancer admitted to a tertiary academic medical center between 1995 and 2004 were reviewed. Gallbladder cancer was found incidentally in 53 patients (50%). Fifty-two of these patients underwent a routine laparoscopic cholecystectomy and were found to have gallbladder cancer intraoperatively or following the operation by subsequent pathologic evaluation of the specimen. Gallbladder cancer had been diagnosed preoperatively by radiology in the other 54 patients (50%). These patients did not undergo laparoscopic cholecystectomy and were explored electively. RESULTS: The median age at presentation was 67 years and 66% were female. Patients who were found to have gallbladder carcinoma incidentally at laparoscopic cholecystectomy had a significant increase in survival when compared with those who were admitted electively with a known diagnosis (P < 0.001). All patients who presented with a known diagnosis had stage II or greater disease, and 36% of these were stage IV carcinomas. However, 82% of those patients who were found incidentally were stage I or II. The overall 5-year survival for all patients was 15%; those discovered incidentally at laparoscopic cholecystectomy had a 5-year survival of 33%. This difference was significant among patients with stage II carcinomas. In the laparoscopic group, there was no difference in survival between the patients who were immediately converted to an open resection when identified to have gallbladder cancer intraoperatively (n = 6) and those who had a completed laparoscopic cholecystectomy and were re-explored at a later point when found to have gallbladder cancer by subsequent pathology (n = 33). There was a significant improvement in survival in 50 patients (47%) who underwent some form of radical resection (P < 0.001). Stage for stage comparison showed that this was significant in stage II disease. Patients who underwent hepatic resection along with lymphadenectomy and extra hepatic biliary resection had similar survival compared with those who had hepatic resection and lymphadenectomy alone. CONCLUSIONS: Laparoscopic cholecystectomy appears to have resulted in the earlier discovery of gallbladder cancer in some patients, resulting in increased probability of survival. Patients discovered with gallbladder carcinoma during a laparoscopic cholecystectomy do not have to be converted immediately to an open resection and should be referred to a tertiary care center for further exploration. Adjunctive radical surgical resection, either at the time of cholecystectomy or subsequently, increases survival significantly in early stage disease.     

腹腔镜胆囊切除术中意外胆囊癌12例诊治分析

目的:探讨腹腔镜胆囊切除术(LC)中意外胆囊癌(unexpected gallb ladder carc inom a,UGC)的处理措施。方法:回顾分析本院955例LC术中遇到的12例(1.26%)UGC的临床资料。结果:随诊3~36个月,平均18个月。迄今全部存活。5例PT1、5例PT2、1例PT3(中转开腹)随访至今未发现癌复发及转移。1例PT2因拒绝根治术,现出现肝多发转移。1例PT4因腹腔种植转移,无法根治,故仅部分切除胆囊(胆囊粘连重),以解决急性胆囊炎问题,现有腹水、恶液质表现。所有病例均未见脐部戳孔处肿瘤种植转移。结论:LC术中应常规切开胆囊标本,必要时送术中冰冻。PT1单纯切除胆囊已足够;PT2要额外楔形切除肝组织及区域淋巴结;PT3中转开腹,行根治手术或姑息手术。     

黄色肉芽肿性胆囊炎的诊治探讨

目的 探讨黄色肉芽肿性胆囊炎的(XGC)的诊断与治疗。方法 回顾10例XGC的临床资料。结果 B超检查10例，CT、检查3例，术前全部误诊，术后病检确诊10例。9例行胆囊切除，1例行胆囊大部切除，其中2例行胆囊床肝脏楔形切除并肝十二指肠韧带淋巴结清扫，1例加胃大部切除。9例治愈，1例死亡。结论 XGC是一种少见特殊类型的慢性胆囊炎，影像学检查易与胆囊癌混淆，确诊依赖病理检查，手术切除胆囊是早期诊断治疗的最佳途径。术中冰冻切片病检．避免手术盲目扩大化。     

Inzidentalome der Leber und der Gallenblase

The expanding use of ultrasound in general practice is leading to an ever increasing rate of detection of true hepatic incidentaloma. The correct diagnosis of hepatic incidentaloma may be made in over 90% with non-invasive means. The questionable diagnosis of "symptomatic" incidentaloma should undergo close scrutiny prior to a decision in favour of surgery. With regard to more recent literature, the former "absolute" requirement for surgical resection in all cases of liver cell adenoma may have to be reappraised. Final inability to rule out malignancy represents an unquestionable indication for surgery in the light of low rates of morbidity and lack of mortality in this otherwise healthy patient group. Percutaneous biopsies should not be performed due to oncological hazards, indeterminate results and potential for acute complications.The stage-oriented radical re-resection following diagnosis of an incidentally detected gallbladder cancer may lead to significantly improved long-term survival, especially in the early tumour stages T1b and T2, which represents the most common stage of gallbladder cancer in incidentaloma. Patients at elevated risk for incidental gallbladder cancer should undergo thorough instruction with regard to the potential hazards of laparoscopic cholecystectomy. Multimodal therapeutic strategies directed at advanced stages of incidentally detected gallbladder cancer should be evaluated in prospective multicentre studies.     

腹腔镜胆囊切除术后常规病理检查的必要性探讨

目的:探讨腹腔镜胆囊切除术(LC)后胆囊常规病理检查的必要性。方法:搜集华西医院病理科5年间的全部胆囊病理报告,找出其中LC术后意外胆囊癌患者,并分析其临床资料。结果:LC术后意外胆囊癌的发生率约为0.28%(36/12 969),88.9%(32/36)为腺癌,58.3%(21/36)为原位癌和早期胆囊癌(T1a和T1b)。结合术前影像学检查,术中通过观察及胆囊标本触摸,成功辨认出34例(94.4%)意外胆囊癌患者存在的可疑病变,遗漏1例原位癌和1例T1a期患者。结论:绝大多数意外胆囊癌患者均可在术中发现可疑病变,极少数肿瘤处于极早期无法发现者,单纯的胆囊切除已达有效治疗。因此,LC术后常规的行胆囊病理检查的必要性有待商榷。     

Multiple port-site metastasis of incidental gallbladder carcinoma after laparoscopic cholecystectomy

Laparoscopic cholecystectomy is a surgical procedure of choice for benign gallbladder diseases. In about 1-2% of cases histopathological examination demonstrate incidental gallbladder cancer (GBCA). We report a case of a 61 year old woman who developed port site metastases after laparoscopic cholecystectomy for adenocarcinoma of the gallbladder. Metastases appeared on all four port sites. Review of literature regarding incidental GBCA an port site metastases was also performed. We conclude that the retrieval bag should be routinely used in laparoscopic cholecystectomy; the procedure should be performed with minimal trauma; in cases of incidental GB carcinoma, full thickness excision of the abdominal wall of the port sites demands additional studies; additional liver bed excision and local lymphadenectomy for T1b carcinoma are yet to be considered.