摘要
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。
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.
出处
《中国临床医学》
2011年第1期72-73,共2页
Chinese Journal of Clinical Medicine