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目的 探讨胆囊癌早期诊治经验。方法 回顾性分析 1993～ 2 0 0 0年腹腔镜术中发现的 41例胆囊癌临床资料。结果 术中探查结合活检明确诊断 36例 (87 8% ) ,术后病理诊断 5例。Ⅰ期胆囊癌行腹腔镜胆囊切除术 (LC)者 ,3年生存率 10 0 % ;Ⅱ期胆囊癌行LC者 ,3年生存率 77 7% ,行根治术者 ,3年生存率 10 0 % ;Ⅲ期胆囊癌行根治术者 ,2年生存率 75 % ,3年生存率 5 0 % ;Ⅳ期胆囊癌行根治术者 ,2年生存率 33% ,3年生存率为 0 ;Ⅲ期胆囊癌 1例 ,仅行LC ,术后 5个月死于肝转移。 15例中转剖腹行根治术者 ,5例未切除套管孔 ,其中 1例切口种植。结论 现代腹腔镜技术可弥补影像学的不足。早期发现胆囊癌并对Ⅱ期以上胆囊癌行根治术 ,能提高术后生存率 ,效果优于仅行LC者 ,对LC中转剖腹手术者 ,应切除套管孔以防切口种植
Objective To explore the early diagnosis and treatment of gallbladder cancer. Methods The clinical data of 41 cases of gallbladder carcinoma found during laparoscopic surgery from 1993 to 2000 were retrospectively analyzed. Results Intraoperative exploration combined with biopsy confirmed the diagnosis of 36 cases (87 8%), postoperative pathological diagnosis in 5 cases. For patients with stage I gallbladder carcinoma undergoing laparoscopic cholecystectomy (LC), the 3-year survival rate was 100%; for patients with stage II gallbladder carcinoma who underwent LC, the 3-year survival rate was 77.7%. For patients undergoing radical resection, the 3-year survival rate was 10%. % of patients with stage III gallbladder cancer underwent radical resection, with a 2-year survival rate of 75% and a 3-year survival rate of 50%; for patients with stage IV gallbladder carcinoma undergoing radical resection, the 2-year survival rate was 33%, and the 3-year survival rate was 0; One case of gallbladder carcinoma, only LC, died of liver metastasis 5 months after surgery. Among the 15 cases who underwent radical laparotomy, 5 cases had no resection of the cannula, and 1 of them had a incision. Conclusion Modern laparoscopic techniques can make up for the lack of imaging. Early detection of gallbladder cancer and radical mastectomy for stage II or higher gallbladder cancer can improve the postoperative survival rate. The effect is better than that of LC alone. For LC laparotomy, the sleeve hole should be resected to prevent incision implantation.