胆囊癌外科治疗中的难点、争议与思考  

Challenges,controversies,and considerations in the surgical treatment of gallbladder cancer

作　　者：冯云翔 邱朋 王剑明[1] FENG Yunxiang;QIU Peng;WANG Jianming(Department of Biliary and Pancreatic Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430000,China)

机构地区：[1]华中科技大学同济医学院附属同济医院胆胰外科,湖北武汉430000

出　　处：《中国普通外科杂志》2025年第2期215-221,共7页China Journal of General Surgery

基　　金：国家自然科学基金资助项目(82373032)。

摘　　要：胆囊癌是胆道系统中最常见的恶性肿瘤,具有隐匿生长、快速进展和跳跃性转移的特点,5年总体生存率仅5%。近年来的靶向和免疫治疗虽不断涌现,但在胆囊癌的治疗中仍处于探索阶段,根治性手术切除仍是目前唯一可能治愈胆囊癌的方法。手术的主要目标是完全切除肿瘤病灶,并进行系统的淋巴结清扫,以降低复发的风险。得益于手术技术的进步和围手术期管理的不断优化,接受扩大胆囊癌根治术患者的术后并发症和住院病死率有所下降。然而,胆囊癌复杂的扩散和转移机制导致确定手术切除的最佳范围十分困难。不同国家的临床指南和各肝胆外科中心在手术方案的选择上意见并不一致,尤其是在肝切除的合理范围、淋巴结清扫的范围及其对预后的影响,以及是否应常规进行肝外胆管切除等方面,存在较多争议。未来仍需要开展大型前瞻性队列研究来为胆囊癌的外科治疗提供更多的循证医学证据。当前,在制定手术方案时,外科医生需要综合考虑患者术前检查结果、术中所见以及冷冻切片的病理评估,在根治与安全和有效之间寻求平衡,选择最适合患者的手术方式,同时重视多学科协作体系的建设,根据肿瘤的准确分期,在术后结合有效辅助治疗,方能在改善患者的预后方面继续取得进展。Gallbladder cancer is the most common malignant tumor of the biliary system,characterized by insidious growth,rapid progression,and skip metastasis.The 5-year overall survival rate is only 5%.Although targeted immunotherapies have emerged in recent years,they are still in the exploratory phase for the treatment of gallbladder cancer,and radical surgical resection remains the only potentially curative treatment.The main goal of surgery is to completely remove the tumor and perform systematic lymph node dissection to reduce the risk of recurrence.Thanks to advances in surgical techniques and continuous optimization of perioperative management,postoperative complications,and hospital mortality in patients undergoing extended radical surgery for gallbladder cancer have decreased.However,the complex mechanisms of gallbladder cancer spread and metastasis make it challenging to determine the optimal scope of surgical resection.Clinical guidelines from different countries and hepatobiliary surgery centers often vary on surgical options,especially regarding the reasonable extent of liver resection,the scope of lymph node dissection and its impact on prognosis,and whether routine extrahepatic bile duct resection should be performed.There remains significant controversy in these areas.Future extensive prospective cohort studies are still needed to provide more evidence-based medical data for the surgical treatment of gallbladder cancer.When designing a surgical plan,surgeons must consider preoperative examination results,intraoperative findings,and pathological evaluation of frozen sections.A balance must be struck between radical treatment and safety and effectiveness.The most appropriate surgical method for each patient should be chosen while also emphasizing establishing a multidisciplinary collaborative system.Based on accurate tumor staging,postoperative adjuvant therapies should be integrated to continue making progress in improving patient prognosis.

关 键 词：胆囊肿瘤 肝切除术 淋巴结切除术 肝外胆管切除术 

分 类 号：R735.8[医药卫生—肿瘤]