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根治性手术切除是外科医生改善胆囊癌病人长期预后最为有效的治疗手段。手术的终极目标是:在病人可耐受的前提下、最大程度的实现R0切除,即所有切缘阴性以及转移淋巴结的彻底清扫。严格的手术质量控制是达成这一目标的核心步骤,主要包括:(1)详尽的术前评估,尽可能地明确术前分期(第7版AJCC胆囊癌TNM分期)。(2)结合探查及术中冰冻病理学检查进一步完善分期,并相应的选择手术切除及淋巴结清扫范围。(3)遵循肿瘤外科的规范化的手术操作要求。(4)规范化的术后标本管理及病人随访。此外,腹腔镜技术的发展为胆囊癌根治性手术提供了微创化的可能,而新兴的可视化外科技术必将推动胆囊癌根治术的精准化进程。
Radical surgery is the most effective treatment for surgeons to improve the long-term prognosis of patients with gallbladder cancer. The ultimate goal of surgery is to achieve maximum R0 resection, that is, all negative margins and thorough clearance of metastatic lymph nodes, as long as the patient can tolerate it. Strict surgical quality control is the core step to achieve this goal. It mainly includes: (1) Detailed preoperative assessment and preoperative staging (7th edition of AJCC gallbladder cancer TNM staging) as far as possible. (2) Combining exploration and intraoperative frozen pathology to further improve the staging, and the corresponding choice of surgical resection and lymph node dissection. (3) Follow the standardized surgical operation requirements of tumor surgery. (4) Standardized post-surgical specimen management and patient follow-up. In addition, the development of laparoscopic techniques offers the possibility of minimally invasive surgery for radical gallbladder cancer, and the emerging visual surgical techniques will certainly promote the precision of gallbladder cancer radical surgery.