CAJ | 학술논문

目的探讨腹腔镜辅助下术中或术后意外发现的早期胆囊癌行根治术的可行性.方法回顾性分析2007年1月至2013年8月在我科腹腔镜下胆囊切除术中或术后病理发现的34例原发性胆囊癌患者的临床资料.其中29例为术中快速病理确诊为胆囊癌,5例为术后病理确诊为Ⅰ期、Ⅱ期胆囊癌.结果 34例患者均成功完成了标准的胆囊癌根治术,其中20例Ⅰ期、Ⅱ期和Ⅲ期中肿瘤仅浸透浆膜,或肿瘤侵犯肝的深度不足2 cm的患者行腹腔镜下单纯胆囊切除术或根治性/扩大根治性胆囊切除术,9例中转开腹行根治性/扩大根治性胆囊切除术或联合肝段/叶切除的胆囊根治性切除术.5例单纯胆囊切除术后病理确诊为胆囊癌的患者再次行腹腔镜下胆囊癌根治性/扩大根治性手术.结论胆囊癌Ⅰ期、Ⅱ期和Ⅲ期中肿瘤仅浸透浆膜,或肿瘤侵犯肝的深度不足2 cm的患者均应行根治性或扩大根治性胆囊切除术.行腹腔镜辅助下根治性或扩大根治性胆囊切除术短期治疗效果满意,5年生存率两者差异无统计学意义.且具有更低的疼痛不适率,更短的住院时间,可以达到与开腹同样的手术效果,达到了根治的要求.
목적 탐토복강경보조하술중혹술후의외발현적조기담낭암행근치술적가행성.방법 회고성분석2007년1월지2013년8월재아과복강경하담낭절제술중혹술후병리발현적34례원발성담낭암환자적림상자료.기중29례위술중쾌속병리학진위담낭암,5례위술후병리학진위Ⅰ기、Ⅱ기담낭암.결과 34례환자균성공완성료표준적담낭암근치술,기중20례Ⅰ기、Ⅱ기화Ⅲ기중종류부침투장막,혹종류침범간적심도불족2 cm적환자행복강경하단순담낭절제술혹근치성/확대근치성담낭절제술,9례중전개복행근치성/확대근치성담낭절제술혹연합간단/협절제적담낭근치성절제술.5례단순담낭절제술후병리학진위담낭암적환자재차행복강경하담낭암근치성/확대근치성수술.결론 담낭암Ⅰ기、Ⅱ기화Ⅲ기중종류부침투장막,혹종류침범간적심도불족2 cm적환자균응행근치성혹확대근치성담낭절제술.행복강경보조하근치성혹확대근치성담낭절제술단기치료효과만의,5년생존솔량자차이무통계학의의.차구유경저적동통불괄솔,경단적주원시간,가이체도여개복동양적수술효과,체도료근치적요구.
Objective To explore the feasibility of radical cholecystectomy for early gallbladder car cinoma found during or after laparoscopic cholecystectomy.Methods A retrospective study was conducted on patients who received laparoscopic cholecystectomy between January 2007 to August 2013 and were diagnosed to have gallbladder cancer during or after the operation.There were 34 patients.In 29 patients intraoperative frozen section diagnosed gallbladder carcinoma.In 5 patients postoperative histopathological study diagnosed stage Ⅰ or Ⅱ gallbladder carcinoma.Results Surgery was conducted successfully on these 34 patients.In 20 patients with stage Ⅰ,Ⅱ and Ⅲ,the tumor had invaded the serosa,or into the liver with a depth of less than 2 cm,laparoscopic cholecystectomy alone or radical/extended radical cholecystectomy were carried out.In 9 patients,the laparoscopic surgery was converted to open surgery and these patients underwent cholecystectomy with resection of the adjacent liver segments/sections.In 5 patients who were diagnosed to have gallbladder carcinoma after laparoscopic cholecystectomy,they were re-operated with laparoscopic radical cholecystectomy.Conclusions Stage Ⅰ,Ⅱ and Ⅲ gallbladder carcinoma with tumor invasion into serosa,or patients with tumor invasion into the liver with a depth of less than 2 cm should undergo radical or extended radical cholecystectomy.Laparoscopic assisted radical or extended radical cholecystectomy could achieve the same operation as with open surgery but with better short-term results.There were less pain,smaller incisions,better scars and shorter hospitalization stay.