腹腔镜手术中意外胆囊癌的临床处理分析.DOCVIP

临床医学论文-腹腔镜手术中意外胆囊癌的临床处理分析 ????????作者：牛伟亚，克力木，张 成，阿扎提，艾克拜尔，王自立 【摘要】? 目的：探讨在腹腔镜胆囊切除术（ＬＣ）中意外发现胆囊癌的治疗方法。方法：对14例LC时意外发现的胆囊癌患者的临床资料进行回顾性分析。结果：4例NevinⅠ、Ⅱ期患者行单纯LC，2例Ⅲ期和3例Ⅳ期患者行LC中转开腹+局部淋巴结清扫术+肝脏楔形切除术，5例Ⅴ期患者行胆囊姑息性切除术。全组意外胆囊癌的发生率为0.06%。结论：Ⅰ期的意外胆囊癌行LC可达到根治目的，Ⅱ期行胆囊切除+肝脏部分切除+术后化疗，Ⅲ、Ⅳ期需行胆囊癌根治术，Ⅴ期根据情况行胆囊切除或姑息手术。 ??? 【关键词】? 腹腔镜；胆囊癌 ???? Analysis of clinical management for unsuspected gallbladder carcinomas discovered during laparoscopy NIU Weiya, KE Limu,ZHANG Cheng,et al.Dept.of Laparoscopic Surgery,People′s Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830001,China ??? 【Abstract】? Ｏbjective:To assess the surgical approaches for unsuspected gallbladder carcinomas (UGC) discovered during laparoscopic cholecystectomy(LC).Methods:Based on clinical data,retrospective analysis were carried out for 14 patients with UGC? discovered during LC.Results:4 patients with tumors of Nevins stageⅠor stageⅡunderwent simple LC alone;2 patients with tumors of stage Ⅲ and 3 patienrs with tumors of stage Ⅳ were converted to laparotomy,and performed wedge excision of gallbladder bed and regional lymphadenectomy;5 patients with tumors of stage Ⅴ were employed for palliative cholecystectomy.In this series, the incidence of UGC was 0.06%.Conclusions:UGC of ＳtageⅠmay be cured after simple LC,while these of stage Ⅱshould receive cholecystectomy and partial liver resection with postoperative chemitherapy.UGC of stageⅢ and Ⅳ should be referred for radical operation,and those of stage Ⅴ can be treated with cholecystectomy or other palliative surgical procedures. ??? 【Key words】? Laparoscopy;Gallbladder carcinoma ??? 腹腔镜胆囊切除术(LC)目前已成为治疗胆囊良性疾病的标准术式，在术中或术后病理检查发现的胆囊癌被称为意外胆囊癌（UGC）。我院自1992～2005年行LC 24 000余例，发现UGC 14例，现就其诊断与处理方法进行分析。 ??? 1? 资料与方法 ??? １１? 临床资料? 本组男3例，女11例，33～79岁，平均66岁。7例以反复右上腹疼痛或不适为主要症状，最长病史达35年，3例有发热、恶心、呕吐，3例体检发现胆囊隆起性病变，1例既往有胃癌手术史，全组病例均无黄疸症状，B超检查均为急、慢性胆囊炎并胆囊结石或胆囊息肉，术前均未行CT检查，9例见胆囊壁增厚＞05cm，术前诊断胆囊炎胆结石11例，胆囊隆起性病变3例。 ??? 12? Nevin分期与手术方式? 14例均先行LC术，全组病例术后病理诊断为胆囊癌，4例Nevin分期为Ⅰ、Ⅱ期的患者行LC后均未再行手术，5例Ⅲ、Ⅳ期因胆