CAJ | 학술논문

目的：探讨腹腔镜胆囊切除术（ LC）意外胆囊癌（ UGC）的处理对策。方法回顾性分析我院2005年1月至2012年10月3355例LC，术中和术后发现的8例UGC的临床资料。结果8例UGC，占同期LC的0.24％（8/3355），术中发现4例，术后发现4例。根据TNM分期（第7版，2009），其中pTis 2例，pT1b 1例，pT23例，pT42例。pTis及pT1b患者仅行LC，术后均长期存活，最长已超过5年；pT2中2例中转开腹行胆囊癌根治术，术后存活已达半年以上；1例因术后发现，患者拒绝再次手术，术后半年复发；pT4中1例因累及肝脏及肝外胆管，拒绝进一步手术，仅行LC，术后3个月出现戳孔种植，术后6个月死于腹腔广泛转移；1例中转开腹行姑息胆囊切除并取活检，3个月后死于多脏器衰竭。无围手术期死亡患者。结论重视胆囊癌高危因素、完善的术前检查、术中对胆囊标本仔细剖检和快速冰冻检查以及确诊后必要的中转开腹是提高胆囊癌早期确诊率、改善胆囊癌预后的关键。术中应切实采取相关措施降低肿瘤细胞腹腔转移与切口种植的发生率。
목적：탐토복강경담낭절제술（ LC）의외담낭암（ UGC）적처리대책。방법회고성분석아원2005년1월지2012년10월3355례LC，술중화술후발현적8례UGC적림상자료。결과8례UGC，점동기LC적0.24％（8/3355），술중발현4례，술후발현4례。근거TNM분기（제7판，2009），기중pTis 2례，pT1b 1례，pT23례，pT42례。pTis급pT1b환자부행LC，술후균장기존활，최장이초과5년；pT2중2례중전개복행담낭암근치술，술후존활이체반년이상；1례인술후발현，환자거절재차수술，술후반년복발；pT4중1례인루급간장급간외담관，거절진일보수술，부행LC，술후3개월출현착공충식，술후6개월사우복강엄범전이；1례중전개복행고식담낭절제병취활검，3개월후사우다장기쇠갈。무위수술기사망환자。결론중시담낭암고위인소、완선적술전검사、술중대담낭표본자세부검화쾌속빙동검사이급학진후필요적중전개복시제고담낭암조기학진솔、개선담낭암예후적관건。술중응절실채취상관조시강저종류세포복강전이여절구충식적발생솔。
Objective To explore the treatment strategIES for unsuspected gallbladder carcinoma ( UGC)during or after laparoscopic cholecystectomy( LC). Methods The clinical data of 8 UGCs in 3355 cases of LC from January 2005 to October 2012 at the First Affiliated Hospital of Harbin Medical Universi-ty were analyzed retrospectively. Results In the 8 cases of UGC,4 were discovered intraoperatively and 4 were discovered postoperatively,accounting for 0. 24%(8/3355)of LC. According to the TNM system(7th edition,2009),Pathological stage was pTis in 2 cases,pT1b in 1 case,pT2 in 3cases,and pT4 in 2 cases. Simple LC was only performed in patients of stage pTis and pT1b. These patients had a long-term survival and the longest had reached more than 5 years. In patients of stage pT2,2 patients were converted to open radical resection and they had survived for more than 6 months postoperatively. The rest refused reoperation and recurred 6 months after operation. In patients of stage pT4,one refused further surgery because of the involvement of liver and extrahepatic duct. The patient received LC only and trocar site seeding was ob-served after 3 months. At the six month after LC,the patient died of widespread metastasis in the abdomen. The other one was converted to open cholecystectomy and biopsy and died of multiple organ failure( MOF) after 3 months. No one died during the perioperative period. Conclusion Attention of risk factors,suffi-cient preoperative examination,careful intraoperative autopsy,fast frozen section and essential conversion to open surgery are crucial for the improvement of early diagnosis and prognosis of gallbladder carcinoma. However,practical measures should be intraoperatively taken to reduce the rate of widespread metastasis and trocar site seeding.