CAJ | 학술논문

目的：研究探讨腹腔镜胆囊切除术术中或术后发现意外胆囊癌的治疗方法。方法术前没有发现胆囊癌,在腹腔镜胆囊切除术术中、术后发现意外胆囊癌的患者34例(术中快速或术后病理)作为研究对象,回顾性分析患者的基本临床资料及诊治的方法和效果。结果34例意外胆囊癌患者术后均经病理证实,腺癌和鳞癌分别有30例和4例,按照Nevin分期的标准对患者评估,Ⅰ期患者4例,Ⅱ期患者11例,Ⅲ期患者13例,郁期患者6例。5例患者仅行腹腔镜胆囊切除术,27例患者行胆囊癌根治术或在胆囊切除术术中转开腹手术,2例患者行姑息性手术。术后平均住院时间(22.4依3.9)d,并发症发生率为11.8%。经随访,5年后存活8例,死亡26例,存活率为23.5%。结论重视腹腔镜胆囊切除术术前的影像学检查,术中做好标本剖检工作,放宽冰冻切片检查的标准,降低漏诊率。发现意外胆囊癌要立即采取合适的治疗方法,提高根治率和患者的生存率。
목적：연구탐토복강경담낭절제술술중혹술후발현의외담낭암적치료방법。방법술전몰유발현담낭암,재복강경담낭절제술술중、술후발현의외담낭암적환자34례(술중쾌속혹술후병리)작위연구대상,회고성분석환자적기본림상자료급진치적방법화효과。결과34례의외담낭암환자술후균경병리증실,선암화린암분별유30례화4례,안조Nevin분기적표준대환자평고,Ⅰ기환자4례,Ⅱ기환자11례,Ⅲ기환자13례,욱기환자6례。5례환자부행복강경담낭절제술,27례환자행담낭암근치술혹재담낭절제술술중전개복수술,2례환자행고식성수술。술후평균주원시간(22.4의3.9)d,병발증발생솔위11.8%。경수방,5년후존활8례,사망26례,존활솔위23.5%。결론중시복강경담낭절제술술전적영상학검사,술중주호표본부검공작,방관빙동절편검사적표준,강저루진솔。발현의외담낭암요립즉채취합괄적치료방법,제고근치솔화환자적생존솔。
Objective To investigate the treatment of intraoperative or postoperative unsuspected gal bladder cancer in laparoscopic cholecystectomy. Methods A retrospective analysis was made of clinical data of patients and treatment Methods and Results of 34 cases of unsuspected gal bladder cancer found during or after laparoscopic cholecystectomy. Results Al of the 34 cases were pathological y confirmed as unsuspected gal bladder cancer,and there were 30 cases of adenocarcinoma and 4 cases of squamous carcinoma. According to Nevin staging criteria for patient assessment, there were 4 cases of period Ⅰ, 11 cases of period Ⅱ, 13 cases of period Ⅲ, and 6 cases of period Ⅳ. Laparoscopic cholecystectomy was operated along in 5 cases, while 27 cases was treated by gal bladder surgery or laparotomy cholecystectomy surgery, and 2 cases underwent pal iative surgery. The average postoperative hospital stay was (22.4±3.9) d, and the incidence of complications was 11.8%.The fol ow-up showed there were 8 survival cases and 26 death cases. The survival rate was 23.5%. Conclusion It is important to pay at ention to preoperative imaging examination of laparoscopic cholecystectomy, to do intraoperative specimens autopsy work, to enlarge the standard of frozen section examination in order to reduce the misdiagnosis rate. Appropriate treatment Methods should be conducted when unexpected gal bladder cancer is found, so as to increase the cure rate and survival rate.