腹腔镜胆囊切除术意外胆囊癌的处理对策

目的探讨腹腔镜胆囊切除术意外胆囊癌的处理对策。方法回顾性分析我院2001年1月至2010年12月4236例腹腔镜胆囊切除术中和术后发现的18例意外胆囊癌的临床资料。结果18例意外胆囊癌，pTis期1例，pTla期5例，pTlb期4例，pT2期5例，pT3期2例，pT4期1例。pTis期及pTl期仅行LC术；pT2期5例中4例行开腹胆囊癌根治术，1例拒绝再次手术；pT3期患者拒绝再次手术；pT4期患者仅行腹腔镜探查活检术。1例腹腔镜胆囊切除术后腹壁Tro-car出现种植转移灶。18例患者术后随访3～64个月，死亡12例，6例仍存活。结论意外胆囊癌的早期确诊有助于改善预后，对pT2期的意外胆囊癌宜再次开腹做根治性手术，pT3期及pT4期意外胆囊癌须权衡手术风险和生存利益作出选择。

Treatment strategy for unsuspected gallbladder carcinoma during laparoscopic cholecystectomy

Objective To explore the treatment strategy for unsuspected gallbladder carcinoma （UGC） during laparoscopic eholeeystectomy （LC）. Methods The clinical data of 18 UGCs in 4236 cases of LC from January 2001 to December 2010 were analyzed retrospectively. Results In 18 cases of UGC, tumors were stage pTis in 2 cases,pTla in 5 ,pTlb in 4 ,pT2 in 5 ,pT3 in 1 ,and pT4 in 1. In patients with pTis and pT1 only LC was performed. In 5 patients with pT2,4 underwent radical resection,and 1 refused reoperation; The patient with pT3 refused reoperation; The patient with pT4 only adopted laparoscopic bi- opsy. Implantation metastasis lesions were found in 1 case as abdominal wall recurrence at trocar site after LC. In 18 patients with follow -up of 3 -64 months, 12 patients died ,6 patients were still alive. Conclusion Early diagnosis of UGC can improve the prognosis. For pT2 UGC, an additional open radical surgery is appropriate ; For pT3 and pT4 UGC, the surgery risk and survival benefit must be weighed to make a decision.