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目的:探讨术中冰冻或术后石蜡病理报告T1b期胆囊癌的外科治疗策略。方法:回顾42例T1b期胆囊癌患者的病理资料,其中14例为术中冰冻病理,28例为术后石蜡病理。经病理科医师重新复核,26例明确为T1b期胆囊癌,其中25例患者获得完整随访资料,本研究对其进行进一步的分析。结果:14例冰冻病理为T1b期患者仅2例石蜡病理为T1b期,其余11例为T2期,1例为T3期,冰冻病理误诊率为85.7%,石蜡病理均等于或高于冰冻病理分期;28例石蜡病理为T1b期胆囊癌患者2例复核为T2期,石蜡病理误诊率为7.1%,复核结果均等于或高于原分期。25例复核明确且有完整随访资料患者术后病理均未见胆囊脉管内癌栓或神经侵犯,其中14例行根治手术患者送检淋巴结30枚,均未见癌转移。25例患者中11例仅行单纯胆囊切除术,其余14例追加腹腔镜或开腹根治手术,两组间生存率差异无统计学意义(P=0.361)。术后仅1例腹腔镜根治术且行胆囊减压的患者发生腹腔种植转移,术后2年广泛种植转移死亡。结论:胆囊切除术中冰冻病理T1b期胆囊癌应行同期根治手术,术后石蜡病理T1b期胆囊癌应复核其T分期,对复核明确的T1b期胆囊癌需慎重评估追加根治手术的利弊,如果术中有胆囊破损建议积极化疗。
Objective: To investigate the surgical treatment strategy of intraoperative frozen or postoperative paraffin pathology T1b gallbladder carcinoma. Methods: The pathological data of 42 patients with T1b gallbladder carcinoma were retrospectively reviewed. Among them, 14 were intraoperative frozen pathology and 28 were postoperative paraffin pathology. Twenty-six patients were diagnosed as T1b gallbladder cancer by pathologist, and 25 patients were followed up for complete follow-up data. In this study, further analysis was performed. Results: In the 14 patients with T1b disease, only 2 patients with T1b stage and the remaining 11 patients with T1b stage and 1 patient with T3 stage, the pathological misdiagnosis rate of frozen pathology was 85.7%. The paraffin pathology was equal to or higher than that of frozen pathological stage ; 28 cases of paraffin pathological T1b gallbladder cancer in patients with 2 cases of review T2, paraffin pathology misdiagnosis rate was 7.1%, the results of the review were equal to or higher than the original stage. Twenty-five patients with clear and complete follow-up data had no tumor embolus or nerve invasion in the gallbladder. Of the 14 patients undergoing radical operation, 30 were examined for lymph node dissection, and no metastasis was found. Among the 25 patients, 11 patients underwent cholecystectomy only, and the remaining 14 patients underwent additional laparoscopic or laparotomy. There was no significant difference in survival between the two groups (P = 0.361). Only 1 patient underwent laparoscopic radical surgery and undergone gallbladder decompression in patients with peritoneal metastasis, 2 years after the widespread transplant death. Conclusion: Cholecystectomy in frozen pathological stage T1b gallbladder cancer should be performed concurrent radical surgery, postoperative paraffin pathological T1b gallbladder cancer should be reviewed T staging, the review of a clear T1b gallbladder cancer need to be carefully evaluated the advantages and disadvantages of additional radical surgery, if Gallbladder surgery recommended active chemotherapy.