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目的:胆囊切除术中发现的意外胆囊癌(unsuspected gallbladder carcinoma,UGC)的临床诊断及处理并对pT1b期的两种手术方式的生存率进行分析。方法回顾性分析我院在2006年3月~2013年4月经胆囊切除术中、术后发现的29例UGC患者的临床资料。结果29例患者术后均获得随访,随访时间2~60个月,平均24个月。其中术中发现20例,术后发现9例,6例pT1a期均行单纯胆囊切除术,中位生存期40(5~60)个月;11例pT1b期中的6例行胆囊癌根治术,中位生存期25(4~36)个月;5例行单纯胆囊切除术,中位生存期18(3~30)个月,两种术式术后生存期比较差异有统计学意义(P<0.05);8例pT2期行胆囊癌根治术,中位生存期20(3~26)个月;3例pT3行胆囊癌根治术,中位生存期9(4~15)个月;1例pT4期行单纯胆总管引流,术后3月死亡。结论胆囊癌的恶性程度较高,手术切除率低,对于UGC病例要根据分期采取适宜的手术方式,对于胆囊癌pT1b期的手术方式选择目前仍存在争议,本研究认为行胆囊癌根治术可以明显提高患者的生存率。
OBJECTIVE: To diagnose and treat the unexpected gallbladder carcinoma (UGC) found during cholecystectomy and to analyze the survival rates of two surgical approaches during pT1b. Methods The clinical data of 29 patients with UGC found during and after cholecystectomy in our hospital from March 2006 to April 2013 were retrospectively analyzed. Results All the 29 patients were followed up for 2 to 60 months with an average of 24 months. Among them, 20 cases were found in operation, 9 cases were found after operation, and 6 cases were treated with simple cholecystectomy at pT1a stage. The median survival time was 40 (5-60) months. Six cases of 11 cases with pT1b stage underwent radical mastectomy of gallbladder carcinoma, The median survival time was 25 (4 ~ 36) months. The median survival time was 18 (3 ~ 30) months in 5 patients undergoing simple cholecystectomy. There were significant differences in the survival time between the two surgical procedures (P <0.05). The median survival time was 20 (3-26) months in 8 cases of pT2. The median survival time was 9 (4-15) months in 3 cases of pT3. Cases of simple common bile duct drainage pT4, died after 3 months. Conclusions Gallbladder carcinoma is more malignant and has a lower surgical resection rate. It is necessary to choose appropriate surgical procedures according to staging for UGC cases. There is still controversy about the choice of surgical procedure for pT1b stage of gallbladder carcinoma. This study suggests that radical surgery of gallbladder carcinoma can be obvious Improve patient’s survival rate.