腹腔镜胆囊切除术中意外胆囊癌的处理对策

目的 :探讨腹腔镜胆囊切除术 (LC)中有效诊治意外胆囊癌 (unsuspectedgallbladdercarcinoma ,UGC)的方法。方法 :回顾分析LC意外胆囊癌 6例的临床资料。结果 :单纯腹腔镜胆囊切除 2例 ,其中 1例T1 期随访 4年 ,至今存活 ;1例T3 期 ,3月后死亡。LC中转开腹T4期 1例 ,行根治术后 5个月死亡。LC术后二次手术者 3例 ,均为T3 期 ,其中 1例LC后腹腔并切口转移 (portsitemetastases ,PSM) ,姑息外引流术 6个月后死亡 ,余 2例行根治术后全部存活 ,其中 1例超过 2 5个月。结论 :早期警惕 ,术中无瘤操作 ,及时根治切除是延长UGC患者术后生存期及减少切口转移的关键

Clinical measures for diagnosis and treatment of unsuspected gallbladder carcinoma during laparoscopic cholecystectomy

Objective:To explore the diagnosis and treatment of unsuspected gallbladder carcinoma(UGC)during laparoscopic cholecystectomy(LC).Methods:The clinical data of 6 cases with UGC during LC was reviewed retrospectively.Results:LC was performed on 6 cases.One case with T 1,who was performed by LC alone four years ago,is alive to date.Of the 4 cases with T 3,two underwent a second radical operation,one of them had remained free of diseases for more than 25 months.One case underwent no additional procedures,died 3 months later.Palliative operation was adopted by another case,who was found abdominal implantation metastases including port site metastases(PSM) after LC and died 6 months later.The case with T 4 had an open radical operation to which the procedure was converted from LC died 5 months later.Conclusions:It is a key to be the vigilance to early gallbladder cancer and choice timely a second or converted open radical surgery for T 2 T 4.For the PSM and poor survival of the UGC,it is also important for practitioners to stick to the principles of non tumor manipulation when using laparoscopic technique.