目的 评价腹腔镜胆囊切除术（LC）中意外胆囊癌的诊断、处理及预后。方法 对我院2000年1月至2010年1月期间5 832例行LC中16例意外胆囊癌患者的临床资料进行回顾性分析。结果 16例意外胆囊癌中7例行LC，9例行开腹胆囊癌根治术。术后病理TNM分期：Ⅰ期10例，Ⅱ期4例，Ⅲ期2例。16例患者术后随访6～60个月，平均23.3个月。随访期内死亡15例。9例接受胆囊癌根治手术的患者术后1、3、5年生存分别为8/9、4/9及1/9，而7例仅行LC的患者术后1年生存为4/7，无生存超过2.5年者。结论 LC术中应高度警惕意外胆囊癌的发生，意外胆囊癌多为早期，应及时中转开腹行胆囊癌根治术，仅行单纯的LC治疗效果欠佳。
Objective To summarize the clinical characteristics of laparoscopic unexpected gallbladder cancer (UGC), and to explore the impact of TNM stage and secondary surgery timing on postoperative survival. Methods Clinical data of 70 UGC patients who treated in Xianyang Hospital of Yanan University and The First Affiliated Hospital of Xi’an Jiaotong University from January 2008 to January 2014 were retrospectively analyzed. The influencing of TNM staging and secondary surgery timing on the prognosis of UGC patients were analyzed by single factor analysis. Results Of the 70 patients before operation, 68 patients (97.2%) were diagnosed as calculus of gallbladder, 1 patient (1.4%) was diagnosed as gallbladder polyps, 1 patient (1.4%) was diagnosed as intrahepatic and extrahepatic bile duct stone. TNM staging: 2 patients (2.9%) in stage 0, 9 patients (12.9%) in stage Ⅰ, 50 patients (71.4%) in stage Ⅱ, 6 patients (8.6%) in stage Ⅲa, 1 patient (1.4%) in stage Ⅲb, 1 patient (1.4%) in stage Ⅳa, and 1 patient (1.4%) in stage Ⅳb. Fifty-five patients (78.6%) were confirmed by intraoperative frozen section examination, and 15 patients (21.4%) were confirmed after laparoscopic surgery. There were 66 patients were followed-up for 2-79 months, and the median follow-up time was 28-month, the 1-， 3-, and 5-year survival rates were 92.3%, 70.7%, and 53.7% respectively. The survival curves of stage 0, Ⅰ, Ⅱ, and Ⅲ+Ⅳ were differed significantly (P ＜0.01), the survival situation was best in patients in stage 0 and Ⅰ, but worst in patients in stage Ⅲ+Ⅳ. There was no statistical difference between the prognosis of patients underwent one-stage surgery and those underwent two-stage surgery (P=0.73). Conclusions A large proportion of UGC are in stage Ⅱ. For UGC patients, the prognosis is related with the clinical stage, so the surgical approach does not worsen the prognosis, regardless whether the tumor is detected during or after laparoscopic cholecystectomy.
ObjectiveTo understand the current progress of diagnosis and treatment of accidental gallbladder cancer.MethodThe relevant literatures about diagnosis and treatment of accidental gallbladder cancer and gallbladder cancer were analyzed and summarized.ResultsDue to the lack of specific symptoms and signs in most patients with accidental gallbladder cancer at the early stage, appropriate imaging examinations and tumor marker examinations could improve the preoperative diagnosis rate. The radical resection was the most effective method for accidental gallbladder cancer, but there were still some controversies about the scope of resection according to different tumor stages, the choice of laparoscopic cholecystectomy or open cholecystectomy, and the timing of reoperation. The postoperative adjuvant therapy could improve the prognosis of patients, but most patients didn’t receive adjuvant therapy after surgery.ConclusionsMost patients with accidental gallbladder cancer are in the early stage, and most of them could obtain radical resection. If the first operation fails to achieve radical resection or postoperative pathological examination to confirm the diagnosis, comprehensive evaluation of the tumor stage and the patient’s general condition should be performed, and remedial treatment should be taken as soon as possible.