意外胆囊癌19例的诊断与治疗(1)
[摘要] 目的 探讨意外胆囊癌(unexpected gallbladder carcinoma，UGC)的诊断和治疗。 方法 回顾性分析2011年1月～2014年10月在我院行经腹腔镜胆囊切除术(laparoscopic cholecystectomy，LC)中发现的意外胆囊癌19例的临床资料。 结果 19例意外胆囊癌患者在首次行经腹腔镜胆囊切除术时，术中快速冰冻病理诊断T1b期4例，T2期2例，T3期1例胆囊癌患者，行开腹胆囊癌根治术，术后病理诊断T1b期2例，T2期1例，这3例患者在LC术后3～4周行开腹胆囊癌根治手术;另有9例Tis和T1a期患者，仅行LC治疗。19例患者的5年存活率78.95%(15/19)，15例Tis期至T1b期患者，5年存活率93.33%(14/15);9例Tis和T1a期患者，5年存活率100%。 结论 Tis及T1a期胆囊癌LC手术效果满意，LC治疗意外胆囊癌可行、安全、有效，重视意外胆囊癌，提高意外胆囊癌的检出率。
[关键词] 意外胆囊癌;诊断;治疗;腹腔镜胆囊切除术;胆囊癌
[中图分类号] R735.8 [文献标识码] B [文章编号] 1673-9701(2020)09-0060-04
[Abstract] Objective To investigate the diagnosis and treatment of unexpected gallbladder carcinoma(UGC). Methods The clinical data of 19 cases of unexpected gallbladder carcinoma found in laparoscopic cholecystectomy (LC) from the Second Affiliated Hospital of Zhengzhou University of Henan Province from January 2011 to October 2014 were retrospectively analyzed. Results During the first laparoscopic cholecystectomy in 19 patients with unexpected gallbladder cancer， 4 patients were diagnosed with stage T1b， 2 patients with stage T2， and 1 patient with stage T3 gallbladder cancer by rapid freezing pathology. And they underwent radical gallbladder carcinoma. Two patients were diagnosed as T1b， and one was diagnosed as T2. The 3 patients were treated with open radical gallbladder carcinoma at 3-4 weeks after LC. 9 patients with Tis and T1a stage were treated with LC only， The 5-year survival rate of 19 patients was 78.95%(15/19). The 5-year survival rate of 15 patients from Tis to T1b was 93.33%(14/15). The 5-year survival rate of 9 patients with Tis and T1a stage was 100%. Conclusion LC surgery for Tis and T1a gallbladder cancer is satisfactory. LC is an effective， safe and effective method for the treatment of unexpected gallbladder cancer. It is important to increase the detection rate of accidental gallbladder cancer. Attention should be paid to unexpected gallbladder cancer to improve the detection rate of unexpected gallbladder cancer.
[Key words] Unexpected gallbladder cancer; Diagnosis; Treatment; Laparoscopic cholecystectomy; Gallbladder cancer
膽囊癌是胆道系统中最常见的恶性肿瘤之一，多发生于胆囊的体部和底部，病理类型以胆囊腺癌为主，其发病率因地区而异，常见于地理上某些特定区域及发展中国家，胆囊癌在南美洲和亚洲的人群中发病率较高，在发达国家少见。诊断困难、预后不良是胆囊癌的两大特点[1]。在我国胆囊癌是胆道系统的一种常见的恶性肿瘤，其发病率在消化道肿瘤中排第5位，其发病隐匿，5年的生存率低于5%[15]。临床上，因胆囊良性疾病而行胆囊切除术，术中或术后诊断的胆囊癌称之为意外胆囊癌，意外胆囊癌多为早期胆囊癌。近年来，随着腹腔镜胆囊切除术应用越来越多，术中冰冻切片病理诊断技术的普及开展和应用，意外胆囊癌的检出率逐渐增多，其诊断和治疗逐渐引起人们的重视[2]。回顾分析2011年1月～2014年10月，我院普通外科在对胆囊良性疾病行经腹腔镜胆囊切除术中发现的意外胆囊癌19例的临床资料，现报道如下。, 百拇医药(崔贵医 庞志刚)
[关键词] 意外胆囊癌;诊断;治疗;腹腔镜胆囊切除术;胆囊癌
[中图分类号] R735.8 [文献标识码] B [文章编号] 1673-9701(2020)09-0060-04
[Abstract] Objective To investigate the diagnosis and treatment of unexpected gallbladder carcinoma(UGC). Methods The clinical data of 19 cases of unexpected gallbladder carcinoma found in laparoscopic cholecystectomy (LC) from the Second Affiliated Hospital of Zhengzhou University of Henan Province from January 2011 to October 2014 were retrospectively analyzed. Results During the first laparoscopic cholecystectomy in 19 patients with unexpected gallbladder cancer， 4 patients were diagnosed with stage T1b， 2 patients with stage T2， and 1 patient with stage T3 gallbladder cancer by rapid freezing pathology. And they underwent radical gallbladder carcinoma. Two patients were diagnosed as T1b， and one was diagnosed as T2. The 3 patients were treated with open radical gallbladder carcinoma at 3-4 weeks after LC. 9 patients with Tis and T1a stage were treated with LC only， The 5-year survival rate of 19 patients was 78.95%(15/19). The 5-year survival rate of 15 patients from Tis to T1b was 93.33%(14/15). The 5-year survival rate of 9 patients with Tis and T1a stage was 100%. Conclusion LC surgery for Tis and T1a gallbladder cancer is satisfactory. LC is an effective， safe and effective method for the treatment of unexpected gallbladder cancer. It is important to increase the detection rate of accidental gallbladder cancer. Attention should be paid to unexpected gallbladder cancer to improve the detection rate of unexpected gallbladder cancer.
[Key words] Unexpected gallbladder cancer; Diagnosis; Treatment; Laparoscopic cholecystectomy; Gallbladder cancer
膽囊癌是胆道系统中最常见的恶性肿瘤之一，多发生于胆囊的体部和底部，病理类型以胆囊腺癌为主，其发病率因地区而异，常见于地理上某些特定区域及发展中国家，胆囊癌在南美洲和亚洲的人群中发病率较高，在发达国家少见。诊断困难、预后不良是胆囊癌的两大特点[1]。在我国胆囊癌是胆道系统的一种常见的恶性肿瘤，其发病率在消化道肿瘤中排第5位，其发病隐匿，5年的生存率低于5%[15]。临床上，因胆囊良性疾病而行胆囊切除术，术中或术后诊断的胆囊癌称之为意外胆囊癌，意外胆囊癌多为早期胆囊癌。近年来，随着腹腔镜胆囊切除术应用越来越多，术中冰冻切片病理诊断技术的普及开展和应用，意外胆囊癌的检出率逐渐增多，其诊断和治疗逐渐引起人们的重视[2]。回顾分析2011年1月～2014年10月，我院普通外科在对胆囊良性疾病行经腹腔镜胆囊切除术中发现的意外胆囊癌19例的临床资料，现报道如下。, 百拇医药(崔贵医 庞志刚)
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