| 摘要: |
| 目的：总结意外胆囊癌(unsuspected gallbladder cancer)的诊断和治疗经验。方法：回顾性分析我院2000年1月至2007年12月收治的15例意外胆囊癌患者的临床资料,总结临床诊治经验。结果：15例患者术前诊断胆囊结石12例,胆囊息肉2例,胆囊结石合并息肉1例。开腹胆囊切除术5例,行腹腔镜胆囊切除术10例。术后均经病理证实为胆囊癌;Nevin分期：Ⅰ期3例,Ⅱ期7例,Ⅲ期4例,Ⅳ期1例。NevinⅠ期密切观察随访,Ⅱ、Ⅲ期行标准胆囊癌根治术,Ⅳ期行扩大胆囊癌根治术。中位随访时间为5.0年,其中13例存活,2例死亡;5例存活超过5年,5年生存率达84.8％。结论：早期胆囊癌术前很难诊断,术中应常规剖视胆囊,对可疑病变行冰冻切片检查;对NevinⅡ～Ⅳ期的意外胆囊癌应再次开腹行根治性手术。 |
| 关键词: 胆囊肿瘤；意外胆囊癌 诊断 根治性切除 预后 |
| DOI：10.3724/SP.J.1008.2008.00618 |
| 投稿时间：2008-03-04修订日期：2008-04-15 |
| 基金项目: |
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| Diagnosis and treatment of unsuspected gallbladder carcinoma |
| LU Jun-hua1△,YANG Tian1△,GUO Hong-wei2,ZHAO Jun1,YANG Guang-shun1* |
| (1.Department of 2nd Biliary Tract Surgery,Eastern Hepatobiliary Hospital,Second Military Medical University,Shanghai 200438,China;2.Department of General Surgery,Second People’s Hospital of Changzhi,Changzhi 046000) |
| Abstract: |
| Objective：To summarize our experience on the diagnosis and treatment of unsuspected gallbladder carcinoma (UGC)．Methods: The clinical data of 15 patients with AGC,who were treated in our hospital from January 2000 to December 2007, were retrospectively analyzed; and the clinical diagnosis and treatment experience was summarized．Results: Preoperative diagnosis showed that the 15 cases included gallstone in 12 cases,gallbladder polypi in 2,and gallstone associated with polypi in 1.All cases were incidentally discovered during operation,with 5 during open cholecystectomy and 10 during laparoscopic cholecystectomy.All 15 cases were confirmed of gallbladder carcinoma by pathological examination after operation．The tumor stage included Nevin stage Ⅰ in 3 cases,stage Ⅱ in 7,stage Ⅲ in 4 and stage Ⅳ in 1．The patients with UGC at Nevin stage Ⅰ were closely followed up; those at Nevin stageⅡ,Ⅲ underwent radical correction of gallbladder carcinoma; and those at Nevin stage Ⅳ received extended radical resection of gallbladder cancer.The median follow-up time was 5.0 years.Two patients died and 13 survived; 5 patients survived for more than 5 years,with a 5-year survival rate of 84.8%.Conclusion: It is difficult to diagnose early gallbladder carcinoma before operation．The surgeons should be alert to the possibility of gallbladder carcinoma before and during the operation．Routine examination of the resected gallbladder tissues and frozen sections are necessary for suspected lesions．Immediate radical resection is an effective measure to improve the prognosis of UGC.Re-exploration and radical resection should be performed on UGC of Nevin stageⅡ-Ⅳ. |
| Key words: gallbladder neoplasms accidental gallbladder carcinoma diagnosis radical operation prognosis |
