腹腔镜手术意外胆囊癌的处理

Treatment of incidental gallbladder carcinoma discovered during laparoscopic cholecystectomy

关键词:  胆囊切除术，腹腔镜  胆囊肿瘤

Key words:  cholecysteclomy,laparoscopic  gallbladder Neoplasms

摘要:

［目的］探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）中意外胆囊癌（unsuspected gallbladdercarcinoma，UGC）的治疗方法。［方法］回顾分析了3517例腹腔镜胆囊切除术中20例意外胆囊癌的临床资料。［结果］20例均先行LC术，20例中有2例为低分化腺癌，5例中分化腺癌，13例高分化腺癌。所有患者行LC后均未再行手术；1例III期患者行胆囊切除术+局部淋巴结清除，1例Ⅳ期患者行胆囊姑息性切除手术。［结论］LC是早期胆囊癌的首选治疗方式。Ⅰ、Ⅱ期的意外胆囊癌行LC可达到根治目的；Ⅲ期和Ⅴ期的患者应当行根治性切除术。

Abstract:

［Objective］To explore the treatment of incidental gallbladder carcinoma (UGC) discovered during laparoscopic cholecystectomy (LC).［Methods］The clinical data of 20 cases of incidental gallbladder carcinoma discovered during laparoscopic cholecystectomy of 3517 cases were reviewed retrospectively.［Results］Twenty cases were treated by LC and 2 cases were poorly differentiated adenocarcinoma,5 cases were moderate differentiated adenocarcinoma,13 cases were well differentiated adenocarcinoma.One case with Nevin stage Ⅲ was treated with LC and radical local lymphadenectomy and one cases with Nevin stage Ⅳ were treated by LC and gallbladder palliative resection. ［Conclusion］We think that LC was the first choice for early stage gallbladder carcinoma.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.