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目的评价腹腔镜胆囊切除术(LC)中意外胆囊癌的诊断、处理及预后。方法对我院2000年1月至2010年1月期间5 832例行LC中16例意外胆囊癌患者的临床资料进行回顾性分析。结果 16例意外胆囊癌中7例行LC,9例行开腹胆囊癌根治术。术后病理TNM分期:Ⅰ期10例,Ⅱ期4例,Ⅲ期2例。16例患者术后随访6～60个月,平均23.3个月。随访期内死亡15例。9例接受胆囊癌根治手术的患者术后1、3、5年生存分别为8/9、4/9及1/9,而7例仅行LC的患者术后1年生存为4/7,无生存超过2.5年者。结论 LC术中应高度警惕意外胆囊癌的发生,意外胆囊癌多为早期,应及时中转开腹行胆囊癌根治术,仅行单纯的LC治疗效果欠佳。
Objective To evaluate the diagnosis, treatment and prognosis of unexpected gallbladder carcinoma in laparoscopic cholecystectomy (LC). Methods The clinical data of 16 patients with unexpected gallbladder cancer from 5 832 routine LC in our hospital from January 2000 to January 2010 were analyzed retrospectively. Results Of the 16 cases of unexpected gallbladder carcinoma, 7 cases underwent LC and 9 cases underwent radical gallbladder radical mastectomy. Postoperative pathological TNM staging: Ⅰ in 10 cases, Ⅱ in 4 cases, Ⅲ in 2 cases. Sixteen patients were followed up for 6 to 60 months, an average of 23.3 months. 15 cases died during the follow-up period. Nine patients undergoing radical surgery for gallbladder at 1, 3, and 5 years postoperative survival were 8/9, 4/9 and 1/9, respectively, whereas 7 patients who underwent LC only had 1/4 year postoperative survival, No surviving more than 2.5 years. Conclusions LC surgery should be highly vigilant against the occurrence of unexpected gallbladder cancer. Accidental gallbladder cancer is mostly early and should be promptly transferred to radical surgery for gallbladder cancer. The mere LC treatment is not effective.