腹腔镜手术中意外胆囊癌的处理体会

目的：探讨在腹腔镜胆囊切除术（LC）中意外发现胆囊癌的治疗方法。方法：对14例LC时意外发现的胆囊癌患者的临床资料进行回顾分析。结果：4例NevinⅠ、Ⅱ期患者行单纯LC,10例中转开腹,其中2例Ⅲ期和3例Ⅳ期患者行胆囊切除＋肝脏楔形切除＋局部淋巴清扫术,5例V期患者行胆囊姑息性切除术。术后2例失访,随访12例中,3例I期患者,至今存活,未见复发;1例Ⅱ期患者术后15个月死亡,2例III期患者,分别于术后1年内和2年内死亡;2例Ⅳ期及4例V期患者均在术后12个月内死于复发转移。结论：LC术中怀疑为胆囊癌者,应中转开腹,对可疑病灶行冷冻切片检查,并选择相应的手术方式;LC术后病理确诊为胆囊癌,侵犯深度超过肌层者应再次开腹行根治手术。

Clinical Management for Unsuspected Gallbladder Carcinomas Discovered During Laparoscopy

Objective：To assess the surgical approaches for unsuspected gallbladder carcinomas（UGC）discovered during laparoscopic cholecystectomy（LC）.Methods：Based on clinical data,retrospective analysis were carried out for 14 patients with UGC discovered during LC.Results：4 patients with tumors of Nevin＇s stageⅠor stageⅡunderwent simple LC alone;2 patients with tumors of stage Ⅲ and 3 patienrs with tumors of stage Ⅳ were converted to laparotomy,and performed wedge excision of gallbladder bed and regional lymphadenectomy;5 patients with tumors of stage V were employed for palliative cholecystectomy.12 patients were followed-up.Three patients with tumors of Nevin＇s stageⅠwere still alive and have no metastasis.One patients with stageⅡdied after 15 months.2 patients with stage Ⅲ survived for 12 months and 24 months respectively.One patients with stage IV and 4 patients with stage V have metastasis and died in 12 months.Conclusions：Frozen-section examination should be applied for suspected malignancy and patients should received a conversion to open surgery.If the carcinoma invasion deeper than the muscular layer,a secondary radical surgery is necessary in order to achieve better prognosis.