意外胆囊癌手术治疗七例分析  

Clinical analysis of the surgical treatment for unexpected gallbladder carcinoma:report of 7 cases

作　　者：马海宁[1] 冯变喜[1] 

机构地区：[1]山西省人民医院普外16层,太原030012

出　　处：《中华普外科手术学杂志（电子版）》2012年第4期61-63,共3页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘　　要：目的探讨在腹腔镜切除(LC)术中意外发现胆囊癌的处理方法。方法回顾性分析2009年7月至2012年1月221例行LC的患者中,术中意外发现胆囊癌患者7例的临床资料及治疗方法。结果全组意外胆囊癌的发生率为3.17%。未发现NevinⅠ期病例,Ⅱ期患者2例行单纯LC,3例Ⅲ期和1例Ⅳ期患者行LC+局部淋巴结清扫术,1例Ⅴ期患者中转开腹行胆囊切除加T管引流术。Ⅱ期患者术后最长随访3年未见复发,Ⅲ期患者有3例,2例随访2年无复发,1例1年后复发再次行T管外引流+胃空肠吻合术,随访至今半年仍健在。而Ⅳ期患者预后较差,于半年内死亡。结论Ⅰ、Ⅱ期的意外胆囊癌行LC可达到根治目的。Ⅲ、Ⅳ期的患者,对于熟练掌握腔镜技术的术者可以行LC+局部淋巴结清扫术,术中做到无瘤的原则,可以提高胆囊癌的预后。Objective To determine the optimal surgical treatment for unexpected gallbladder carcinoma（UGC） diagnosed by during laparoscopic cholecystectomy（LC）.Methods 221 patients received laparoscopic cholecystectomy from July 2009 to January 2012.Among these patients,7 patients were diagnosed intraoperatively,and their clinical data were reviewed.Results The 7 patients（3.17%）were incidentally confirmed.No patients were in Nevin stageⅠ,2 patients in Nevin stageⅡ who were treated by LC,3 patients in Nevin stageⅢ and 1 patient in Nevin stage Ⅳ,who were treated by LC and radical local lymphadenectomy.One patient in Nevin stageⅤ was treated by open cholecystectomy and T-tube drainage.No recurrence was observed in patients in Nevin stageⅡ during a 3-year follow-up.Among the 3 patients in Nevin stage Ⅲ,2 patients had no recurrence in a 2-year follow-up,and 1 patient underwent reoperation of gastronesteostomy plus T-tube drainage due to local recurrence one year after operation,who was alive in a 6-month follow-up.The prognosis of patients in Nevin stage Ⅳ and Ⅴ was poor with life-span less than 6 months.Conclusions Patients with UGC in Nevin stageⅠ and Ⅱ can be radically treated by LC.Patients with UGC in Nevin stage Ⅲ and Ⅳ can be treated by LC plus radical lymphadenectomy with pretty well prognosis.

关 键 词：胆囊肿瘤 胆囊切除术 腹腔镜 肿瘤分期 

分 类 号：R735.8[医药卫生—肿瘤]