腹腔镜手术意外胆囊癌的处理

目的探讨在腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）中意外发现的胆囊癌的治疗方法。方法对17例LC时意外发现的胆囊癌者的临床资料进行回顾性分析。结果11例NevinⅠ，Ⅱ期患者行单纯LC；1例Ⅲ期和3例Ⅳ期患者行LC＋局部淋巴结清扫术；2例Ⅳ期患者行胆囊切除术。全组意外胆囊癌的发生率为0．6％。Ⅰ，Ⅱ期患者术后最长随访5年，未见复发；Ⅲ期1例术后1．5年复发，再次手术；而Ⅳ，Ⅴ期的病例预后较差，均于1年内死亡。结论Ⅰ，Ⅱ期的意外胆囊癌行LC可达到根治目的。Ⅲ期的需行胆囊癌根治术，如术中做到切缘镜下无瘤可望提高生存率。Ⅴ期应采用局部清扫＋肝脏楔形切除术进行治疗。

The treatment of incidental gallbladder carcinoma discovered during laparoscopic cholecystectomy

Objective To explore the treatment of incidental gallbladder carcinoma(UGC)discovered during laparoscopic cholecystectomy(LC). Methods The clinical data of 17 cases of incidental gallbladder (carcinoma) discovered during laparoscopic cholecystectomy were reviewed retrospectively. Results 11cases with Nevin stage I or stage II were treated by LC and 1 case with Nevin stage III and 3 cases with Nevin stage V were treated by LC and radical local lymphadenectomy. 2 cases with Nevin stage IV were treated by (cholecystectomy). UGC was incidently found in 0.6% of the cases. Cases with Nevin Stage I and II were (observed) for 5 years with no recurrence. A case with Nevin Stage III was found to have recurrence within one and a half years postoperatively and had a re-operation. The prognosis of patients with Nevin Stage IV and V was poor and they were dead within a year after operation. Conclusions The incidently found gallbladder carcinoma with Nevin Stage I and II disease can be radically resected with laparoscopic cholecystectomy. The incidently found gallbladder carcinoma with Nevin Stage III and IV disease needs to be radically resected, and if the resection margin is found to be free of tumour, the prognosis is enhanced. The ones with Nevin Stage V need to be treated by local lymphadenectomy and wedge-resection of liver.