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目的:探讨腹腔镜胆囊切除术后意外发现胆囊癌的处理方法。方法:对1997～2001年14例腹腔镜胆囊切除术中或术后意外发现的胆囊癌进行临床病理分析。结果:14例意外胆囊癌中男2例,女12例。平均年龄66.1岁。术前诊断1例为胆囊息肉,余13例为胆囊炎胆囊结石(92.8%)。有7例中转开腹手术,1例因发现转移仅在腹腔镜下行腹壁肿块活检术,6例完成腹腔镜胆囊切除术。术后病理TNM分期:0期1例,Ⅰ期4例,Ⅱ期3例,Ⅲ期3例,Ⅳb期3例。至随访截止时,已有9人死亡,5人仍存活,存活期超过36个月者有4人,最长者已存活68月。结论:腹腔镜胆囊切除术不适用于胆囊癌病人。提倡腹腔镜术中对可疑病灶进行冰冻切片病理检查。对胆囊癌侵犯深度超过肌层者应中转开腹或术后再次开腹行根治性手术。
Objective: To investigate the treatment of gallbladder cancer after accidental laparoscopic cholecystectomy. Methods: Clinical pathological analysis of 14 cases of gallbladder carcinoma unexpectedly found during or after laparoscopic cholecystectomy from 1997 to 2001 were performed. Results: There were 2 males and 12 females in 14 cases of unexpected gallbladder cancer. The average age is 66.1 years old. One patient had preoperative gallbladder polyps, and the remaining 13 patients had cholecystitis gallstones (92.8%). There were 7 cases of conversion to laparotomy, 1 case of metastasis only in laparoscopic abdominal mass biopsy, and 6 cases of laparoscopic cholecystectomy. Postoperative pathological TNM staging: 0 in 1 case, 4 in stage I, 3 in stage II, 3 in stage III, and 3 in stage IVb. By the time of follow-up, 9 people had died and 5 were still alive. Four of them survived beyond 36 months, and the longest survived 68 months. Conclusion: Laparoscopic cholecystectomy is not suitable for patients with gallbladder cancer. Promote frozen section biopsy of suspicious lesions during laparoscopic surgery. Patients with gallbladder cancer invasion beyond the muscular layer should be converted to open surgery or open surgery after radical resection.