腹腔镜胆囊切除术术中或术后意外胆囊癌的治疗

目的研究探讨腹腔镜胆囊切除术术中或术后发现意外胆囊癌的治疗方法。方法在腹腔镜胆囊切除术术中、术后发现意外胆囊癌的患者34例作为研究对象,回顾性分析患者的基本临床资料及诊治的方法和效果。结果 34例意外胆囊癌患者术后均经病理证实,腺癌和鳞癌分别有30例和4例,按照Nevin分期的标准对患者评估,Ⅰ期患者4例,Ⅱ期患者11例,Ⅲ期患者13例,Ⅳ期患者6例。5例患者仅行腹腔镜胆囊切除术,27例患者行胆囊癌根治术或在胆囊切除术术中转开腹手术,2例患者行姑息性手术。术后平均住院时间（22.4±3.9）d,并发症发生率为11.8%。经随访,存活8例,死亡26例,存活率为23.5%。结论重视腹腔镜胆囊切除术术前的影像学检查,术中做好标本剖检工作,放宽冰冻切片检查的标准,降低漏诊率。发现意外胆囊癌要立即采取合适的治疗方法,提高根治率和患者的生存率。

Treatment of intraoperative or postoperative unsuspected gallbladder cancer in laparoscopic cholecystectomy

Objective To investigate the treatment of intraoperative or postoperative unsuspected gallbladder cancer in laparoscopic cholecystectomy. Methods A retrospective analysis was made of clinical data of patients and treatment Methods and Results of 34 cases of unsuspected gallbladder cancer found during or after laparoscopic eholecystectomy. Results All of the 34 cases were pathologically confirmed as unsuspected gallbladder cancer, and there were 30 cases of adenocarcinoma and 4 cases of squamous carcinoma. According to Nevin staging criteria for patient assessment, there were 4 cases of period Ⅰ, 11 cases of period Ⅱ, 13 cases of period Ⅲ, and 6 cases of period IV. Laparoscopic cholecystectomy was operated along in 5 cases, while 27 cases was treated by gallbladder surgery or laparotomy cholecystectomy surgery, and 2 cases underwent palliative surgery. The average postoperative hospital stay was （22.4 ± 3.9） d, and the incidence of complications was 11.8%.The follow-up showed there were 8 survival cases and 26 death cases. The survival rate was 23.5%. Conclusion It is important to pay attention to preoperative imaging examination Of laparoscopic eholecystectomy, to do intraoperative specimens autopsy work, to enlarge the standard of frozen section examination in order to reduce the misdiagnosis rate. Appropriate treatment Methods should be conducted when unexpected gallbladder cancer is found, so as to inci：ease the cure rate and survival rate.