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目的探讨意外胆囊癌的诊断和处理方法。方法回顾性分析近10年来2所医院15例意外胆囊癌患者的临床资料。结果开腹手术发现8例,腹腔镜胆囊切除术发现7例,其中NevinⅠ期3例,Ⅱ期9例,Ⅲ期2例,Ⅳ期1例。其中10例首次手术中施行根治术,3例术后确诊再行根治术,另2例I期患者行单纯胆囊切除术后病理诊断为癌,未再行手术。Ⅰ、Ⅱ期均随访2年以上仍存活,Ⅲ期病例均术后2年内复发死亡,Ⅳ期半年内死亡。结论早期胆囊癌术前诊断困难,重视其高危因素,术中对可疑病例行快速冰冻切片检查有助于诊断;根治性手术为胆囊癌最有效治疗方法。
Objective To investigate the diagnosis and treatment of unexpected gallbladder cancer. Methods The clinical data of 15 patients with unexpected gallbladder cancer in 2 hospitals in the recent 10 years were retrospectively analyzed. Results 8 cases were detected by laparotomy and 7 cases were diagnosed by laparoscopic cholecystectomy. There were 3 cases of Nevin Ⅰ, 9 cases of stage Ⅱ, 2 cases of stage Ⅲ and 1 case of stage Ⅳ. Among them, radical surgery was performed in 10 cases during the first operation, 3 cases were diagnosed and then underwent radical operation, and the other 2 cases with stage I disease were diagnosed as carcinoma by simple cholecystectomy. No further operation was performed. Stage I and II were followed up for more than 2 years and still survived. Stage III patients relapsed within 2 years after operation and died within 6 months after stage IV. Conclusion Early diagnosis of gallbladder cancer is difficult, pay attention to its high risk factors, intraoperative fast frozen biopsy can help diagnose suspicious cases; radical surgery for the most effective treatment of gallbladder cancer.