腹腔镜胆囊切除术后病理显示为胆囊癌再手术患者的临床分析

目的 探讨胆囊结石行腹腔镜胆囊切除术后病理结果为胆囊癌再手术患者的处理策略.方法 回顾性分析该院普外科2009-2013年因胆囊结石行腹腔镜胆囊切除术后病理发现为胆囊癌患者15例的临床资料.结果 15例患者腹腔镜胆囊切除术后3~5d病理检查为胆囊癌,肿瘤位于胆囊底4例,胆囊体2例,胆囊颈部9例;重度不典型增生局灶癌变1例,高分化腺癌2例,中分化腺癌9例,低分化腺癌3例;Tis 1例,pTⅠa 8例,pTⅠb 6例,胆囊管切缘均为阴性.15例患者均于胆囊切除术后6~11 d再次开腹手术,肝十二指肠韧带淋巴结清扫术,T N M分期0期1例,Ⅰa期8例,Ⅰb期5例,Ⅲb期1例.术后随访时间28~79个月,1年生存率100%,2年生存率100%,3年生存率93%,5年生存率93%;1例Ⅲb期患者术后2年发现梗阻性黄疸,行经皮肝穿刺胆道引流治疗,3个月后死亡.术后均未发现刺口种植转移.结论 腹腔镜胆囊切除术后病理发现的胆囊癌一般病期较早,行肝十二指肠韧带淋巴结清扫术预后相对较好.

Clinical analysis on re-operative patients with gallbladder cancer revealed by pathology examination after laparoscopic cholecystectomy

Objective To investigate the treatment strategy for the re-operation patients with gallbladder cancer revealed by pathological results after laparoscopic cholecystectomy .Methods The clinical data in 15 cases of gallbladder cancer found by pa-thology after laparoscopic cholecystectomy in the general surgery department of this hospital during 2009-2013 were retrospective-ly analyzed .Results The pathological results on 3-5 d after laparoscopic cholecystectomy in 15 cases showed gallbladder cancer , tumor located at the gallbladder fundus in 2 cases ,the gallbladder body in 2 cases and gallbladder neck in 9 cases;there were 1 case of severe atypical hyperplasia ,2 cases of high differentiation adenocarcinoma ,9 cases of middle differentiation adenocarcinoma and 3 cases of low differentiation adenocarcinoma ;there were 1 case of Tis ,8 cases of pT Ⅰa ,6 cases of pTⅠb ,and 15 cases of bile tube incisal edge were negative .All 15 cases received re-laparotomy and hepatic duodenal ligament lymph nodes resection on 6-11 d af-ter cholecystectomy ,There were 1 case in the stage 0 ,8 cases in the stage Ⅰa ,5 cases in the stage Ⅰb ,1 case in the stage Ⅲb by TNM classification .The postoperative follow up lasted for 28 -79 months ,the accumulative survival rate was 100% in 1 year , 100% in 2 year ,93% in 3 year ,93% in 5 year .One case of stage Ⅲb was found repeated metastasis obstructive jaundice ,received transcutaneous puncture bile tract drainage and died after 3 months;no postoperative incision implantation metastasis was found . Conclusion Gallbladder cancer found by pathological examination after laparoscopic cholecystectomy is generally in early stage . Therefore ,early conducting the additional hepatic duodenal ligament lymphadenectomy has relatively good prognosis .