胆囊癌手术质量控制

根治性手术切除是外科医生改善胆囊癌病人长期预后最为有效的治疗手段。手术的终极目标是：在病人可耐受的前提下、最大程度的实现R0切除，即所有切缘阴性以及转移淋巴结的彻底清扫。严格的手术质量控制是达成这一目标的核心步骤，主要包括：（1）详尽的术前评估，尽可能地明确术前分期（第7版AJCC胆囊癌TNM分期）。（2） 结合探查及术中冰冻病理学检查进一步完善分期，并相应的选择手术切除及淋巴结清扫范围。（3） 遵循肿瘤外科的规范化的手术操作要求。（4） 规范化的术后标本管理及病人随访。此外，腹腔镜技术的发展为胆囊癌根治性手术提供了微创化的可能， 而新兴的可视化外科技术必将推动胆囊癌根治术的精准化进程。

Quality control of surgeries for gallbladder carcinom

Quality control of surgeries for gallbladder carcinom                 WANG Jie，XU Jun-yao, JIANG Hai. Department of Hepatobiliary Surgery,Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120,China
Corresponding author:WANG Jie, E-mail:sumsjw@163.com
Abstract    Radical resection controlled by surgeons is the most effective therapeutic option for patients with gallbladder cancer.  The ultimate goal of surgery is to achieve R0 resection, which means negative resection margins as well as the definite clearance of potentially metastatic lymph nodes.  A quality control system should be established to grantee the imperial  role of radical resection on long term outcome, which may include several parts: 1.  To classify the patients into an appropriate TNM stage(AJCC 7th) with comprehensively preoperative examinations, 2. To set up the surgical plan based on the  amended TNM staging , with the combination of  intraoperative exploration and pathological finding, 3. To standardize the surgical procedure with the guidance of oncological rules, 4. To standardize the management  of specimens and postoperative follow-up of patients. Moreover, rapid development of laparoscopic techniques has warranted the possibility of minimally invasive gallbladder carcinoma radical operation. And emerging technology on intraoperative visualization will undoubtedly promote the process of precision surgery for the treatment of gallbladder cancer.