论文部分内容阅读
目的:分析腹腔镜胆囊切除术中或术后发现意外胆囊癌的临床特点,探讨其诊治措施。方法:回顾性分析2008年1月~2012年12月在我院行腹腔镜胆囊切除术治疗发现的意外胆囊癌患者共计32例的临床资料和随访结果。结果:24例患者经术中快速冷冻病理证实,其中12例中转开腹行胆囊癌根治术;8例患者经术后病理证实,6例行二次开腹手术。Nevin I期4例,Nevin II期20例,Nevin III期5例,Nevin IV期2例,Nevin V期1例。32例患者均顺利出院,住院时间6~24d,平均住院时间(13.8±8.1)d。32例中有30例获得随访,2例失访,随访时间2~49个月,平均(24.2±14.6)个月。生存23例,死亡7例,分别死于术后2、3、5、12、14、18和32个月。术后有5例患者出现并发症,2例胆囊积液,2例切口感染和1例胆瘘,经对症治疗后好转。结论:加强对胆囊癌的警惕与认识,腹腔镜胆囊切除术中或术后发现意外胆囊癌后应根据具体情况,选择最佳手术方式治疗,提高根治切除率,延长患者生存期。
Objective: To analyze the clinical characteristics of patients with unexpected gallbladder carcinoma found during or after laparoscopic cholecystectomy and to discuss the diagnosis and treatment measures. Methods: The clinical data and follow-up results of 32 patients with unexpected gallbladder cancer who underwent laparoscopic cholecystectomy in our hospital from January 2008 to December 2012 were retrospectively analyzed. Results: Twenty-four patients were confirmed by rapid frozen pathology. Among them, 12 cases underwent radical cholecystectomy by laparotomy. Eight cases were confirmed by pathology and 6 cases underwent secondary laparotomy. Nevin I 4 cases, Nevin II 20 cases, Nevin III 5 cases, Nevin IV 2 cases, Nevin V 1 case. All 32 patients were discharged smoothly, the hospitalization time was 6 ~ 24 days and the average length of hospital stay was (13.8 ± 8.1) days. Thirty of 32 cases were followed up, 2 cases were lost to follow-up. The follow-up time ranged from 2 to 49 months, with an average of (24.2 ± 14.6) months. Twenty-three patients survived and 7 died. The patients died at 2, 3, 5, 12, 14, 18 and 32 months after operation. Postoperative complications occurred in 5 patients, 2 cases of gallbladder effusion, 2 cases of incision infection and 1 case of biliary fistula, improved after symptomatic treatment. Conclusion: To strengthen the vigilance and understanding of gallbladder cancer, laparoscopic cholecystectomy or surgery after the discovery of unexpected gallbladder cancer should be based on the specific circumstances, choose the best surgical treatment, improve the radical resection rate and prolong the survival of patients.