腹腔镜胆囊切除术术中或术后意外胆囊癌的治疗

目的探讨腹腔镜胆囊切除术（LC）术中发现意外胆囊癌（UGC）的治疗方法。方法回顾分析1996年1月至2010年6月期间5000例行LC患者的临床资料,术后发现UGC12例,结合以往文献对UGC的诊治方法进行分析。结果手术顺利,术中和术后被证实为胆囊癌的患者12例,发生率为0.24%（12/5000）,其中T1期6例,T2期4例,T3期1例,T4期1例。T1期患者仅行LC,除1例于术后第39个月死于其他疾病外均长期存活;T2期仅行LC2例,中转开腹2例,行胆囊癌根治术,术后均长期存活;T3期1例,行LC,于术后第42个月死于肿瘤转移;T4期1例,术中发现腹膜广泛种植,仅行LC,于术后第6个月死亡。有3例发生戳孔种植,T1、T2、T3期各1例。结论胆囊癌存活期短,预后差,但腹腔镜手术发现的UGC大多属早期,采取合适的治疗手段可取得良好的疗效。

Unsuspected gallbladder carcinoma during or afger laparoscopic cholecystectomy

Objective To discuss the treatment of unsuspected gallbladder carcinana（UGC） during and after laparoscopic cholecystectomy（LC）.Methods This study included 5000 patients who underwent LC between January 1996 and June 2010.Twelve patient were detected UGC.The clinic data of 12 UGC patients and recent literatures about UCG during or after LC were reviewed.Results The percentage in patients who underwent LC was 0.24 %（12 of 5000 cases）.According to the TNM system,6 patients had T1 tumors,4 patients had T2 tumors,1 patient had T3 tumors and 1 patient had T4 tumor.All patients with T1 tumor were performed LC only,and all survived well beside one patient died of other diseases 39 months after LC.Two patients with T2 tumor were performed LC and gallbladder carcinoma were diagnosed by frozen section,and were converted to open surgery,were performed the resection of the gallbladder bed and regional lymph node dissection,and the other 2 patients with T2 tumor were performed LC only,or was performed laparoscopic gallbladder bed diathermy after LC.All 4 patients with T2 tumor are still alive now.The patient with T3 tumor was diagnosed UGC after LC,without reoperation,and died of tumor metastasis 42 months after LC.The patient with T4 tumor died 6 months after LC.Trocar sitemetastasis were observed in three patients.Conclusions Mostly,UGC during and after LC in earlier period tumors,and satisfactory therapeutic can be gained from suitable treatments.