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目的探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中发现意外胆囊癌(unexpected gallbladder cancer,UGC)的临床诊治流程及其疗效评价。方法收集解放军第451医院腔镜外科2013年1月至2015年8月期间因胆囊良性疾病行LC术患者的临床资料,共计发现UGC 22例,评价其诊治流程及治疗效果。结果 22例患者手术均获成功,无手术死亡病例。术后无感染、腹腔内出血等严重并发症发生;有2例患者术后出现少量胆汁渗漏,2例患者术后出现腹腔内少量渗血,均经引流2~5 d后好转。术中有6例行冰冻病理学检查确诊,其中重度不典型增生伴局部癌变5例,行单纯胆囊切除术;高分化腺癌1例,中转开腹行胆囊癌根治术。其余16例为术后病理学检查提示胆囊癌,其中13例二次手术行胆囊癌根治术,另3例患者家属放弃二次手术治疗。22例患者中Nevin分期为Ⅰ期17例,Ⅱ期3例,Ⅲ期2例。Ⅰ期、Ⅱ期和Ⅲ期患者术后1年存活者分别为14/17、2/3和0/2例。结论胆囊癌早期诊断困难,术前应对存在危险因素的胆囊良性病变患者提高警惕,早期行手术治疗可提高其临床疗效。
Objective To investigate the clinical diagnosis and treatment of unexpected gallbladder cancer (UGC) in laparoscopic cholecystectomy (LC). Methods Clinical data of LC patients with benign diseases of gallbladder during the period from January 2013 to August 2015 in Department of Endoscopic Surgery, People’s Liberation Army 451 Hospital were collected. A total of 22 cases of UGC were collected to evaluate the diagnosis and treatment process and the therapeutic effect. Results All 22 patients underwent successful surgery without any surgical death. No postoperative infection, intraperitoneal hemorrhage and other serious complications occurred; 2 patients had a small amount of postoperative leakage of bile leakage, 2 patients after surgery a small amount of intraperitoneal bleeding, after 2 to 5 days after drainage improved. Six cases were diagnosed by frozen pathology, including severe atypical hyperplasia with local carcinoid in 5 cases, simple cholecystectomy; 1 case of well-differentiated adenocarcinoma, the conversion of open radical cholecystectomy. The remaining 16 cases of gallbladder cancer prompted postoperative pathological examination, of which 13 cases of radical resection of gallbladder cancer, and the other 3 cases of family members to give up the second surgery. Among the 22 patients, Nevin stage was stage Ⅰ in 17 cases, stage Ⅱ in 3 cases and stage Ⅲ in 2 cases. Patients in stage I, stage II and stage III survived 1 year after operation were 14 / 17,2 / 3 and 0/2, respectively. Conclusion Early diagnosis of gallbladder cancer is difficult. Preoperative management of patients with gallbladder benign lesions who have risk factors should be vigilant. Early surgical treatment may improve their clinical curative effect.