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。

Clinical analysis of unsuspected gallbladder carcinoma during laparoscopic cholecystectomy: areport of 58 cases

Abstract Objective To discuss the diagnosis and treatment of unsuspected gallbladder carcinoma (UGC)during laparoscopic cholecystectomy. Methods The clinical data of 58 UGC patients who treated in ArmedPolice Anhui General Hospital from May 2007 to May 2017 were retrospectively analyzed. Results Twentyfour cases were diagnosed by intraoperative frozen section examination, among them, 22 cases were convertedto laparotomy radical resection. Another 34 cases were diagnosed by postoperative general pathologicalexamination, among them 24 cases were underwent a secondary surgery. According to TNM staging, therewere 12 cases in T1b stage, 34 cases in T2 stage, 6 cases in T3 stage, 6 cases in T4 stage. Non radical group: 20cases, were only performed laparoscopic cholecystectomy, the postoperative cumulative survival rates of 1-,2-, and 3- year were 65.0%, 42.5%, 18.0%. Radical group: 46 cases, were underwent radical cholecystectomy,postoperative cumulative survival rates of 1-, 2-, and 3- year were 82.5%, 62.5%, 45.7%. There was significantdifferent between the two groups (P<0.05). Conclusion The prognosis of UGC is closely related to the surgicaltreatment and TNM staging. For patients with risk factors of gallbladder carcinoma, surgery is recommended asearly as possible. Due to most of UGC belongs to the early stage, intraoperative anatomy of the gallbladder andpathological examination are important. UGC patients with T1b~T3 stage should be performed radical resection,and advanced carcinoma should performed palliative surgery according to patients' condition.