意外胆囊癌的外科诊治现状

意外胆囊癌(incidental gallbladder cancer,IGBC)是指在术前评估为胆囊良性疾病,在行胆囊切除术术中发现或者术后病理确诊的胆囊癌。由于其起病隐匿,早期无特异性临床表现,并且往往合并其他胆囊良性病变,导致术前确诊困难。随着腹腔镜胆囊切除术在各级医院的广泛开展,意外胆囊病例也随之增多。现代影像学、病理学检查有助于提高胆囊癌的术前诊断率,减少意外胆囊癌的发生。第8版AJCC胆囊癌TNM分期对意外胆囊癌手术方式选择与预后判断起着至关重要的指导作用。对于意外胆囊癌的进一步治疗,以根治性手术为主的综合治疗是目前改善意外胆囊癌患者预后最为有效的手段,T2和T3期意外胆囊癌经二次根治性治疗效果明显。单一手术方式并不适用于各期意外胆囊癌,具体手术方式应根据患者肿瘤TNM分期而定。化疗、放疗的综合治疗对于意外胆囊癌虽已取得一定成效,但总体效果尚不满意。目前国内外对意外胆囊癌开展相关研究的重视程度不足,意外胆囊癌相关研究的进展相对缓慢,临床上仍缺乏一个全面有效处理意外胆囊癌的准则与规范,诸多方面仍存在一定的困惑与争议。本文对近年来意外胆囊癌综合治疗的研究进展与疑点进行简要概述。 

Present status of surgical diagnosis and treatment of incidental gallbladder cancer

The incidental gallbladder cancer (IGBC) is defined as the gallbladder cancer, which is diagnosed during or following cholecystectomy by pathological examinations, preoperatively considered as benign gallbladder disease. IGBC is usually not associated with readily discernible clinical signs and combined with other benign lesions. And the early clinical manifestations are usually non-specific. It is more difficult to diagnosis before operation. With the extensive operation of laparoscopic cholecystectomy, the patients with IGBC have increased. Modern imageology can improve the preoperative diagnosis of gallbladder cancer and reduce the incidence of IGBC. TNM staging system (AJCC 8th) for gallbladder cancer has an important guiding significance for treatment selection and prognosis of IGBC. Comprehensive treatment based on radical surgery is the most effective therapeutic option for IGBC. Secondary radical surgery appears to have a clear therapeutic effect in T2 and T3 patients with IGBC. Single surgical approach does not apply to the patients with IGBC in each stage, and the specific surgical approach should be based on TNM staging. Chemotherapy and radiotherapy has achieved certain results in the case of IGBC, but the overall effect is not satisfactory. There is a lack of attention to the research on IGBC at present. Clinically, there is still a lack of effective guidelines to treat IGBC, and the standard surgical regimens for IGBC remained controversial. In this paper, the authors give a brief overview of the research progress and doubtful points in the treatment of IGBC.