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目的探讨意外胆囊癌的诊治。方法分析11例意外胆囊癌的临床资料,总结临床诊治经验。结果11例患者中,术前诊断慢性结石性胆囊炎8例,Mirrizi综合征1例,胆囊息肉2例。2例行腹腔镜胆囊切除术,9例行开腹胆囊切除术。术中冰冻切片证实胆囊癌5例,术后病理确诊6例。Nevin分期:Ⅰ期2例,Ⅱ期5例,Ⅲ期3例,Ⅴ期1例。单纯胆囊切除术5例,胆囊癌根治术5例,胆囊癌根治术+部分胆管切除肝总管空肠吻合术1例。二次手术2例。死亡3例,存活8例。结论重视胆囊癌的高危因素,术中对切除胆囊进行剖检及冰冻切片检查,术后行常规石蜡切片检查,有利于发现意外胆囊癌;术中及时或术后二次手术行胆囊癌根治术可以延长生存时间,改善预后。
Objective To investigate the diagnosis and treatment of unexpected gallbladder cancer. Methods The clinical data of 11 cases of unexpected gallbladder cancer were analyzed and the clinical diagnosis and treatment experience was summarized. Results Among the 11 patients, 8 cases were diagnosed as chronic cholecystitis, 1 case was Mirrizi syndrome and 2 cases were gallbladder polyps. 2 cases of laparoscopic cholecystectomy, 9 cases of open cholecystectomy. Intraoperative frozen section confirmed gallbladder carcinoma in 5 cases, pathologically confirmed in 6 cases. Nevin staging: stage Ⅰ in 2 cases, stage Ⅱ in 5 cases, stage Ⅲ in 3 cases, stage Ⅴ in 1 case. Simple cholecystectomy in 5 cases, gallbladder carcinoma in 5 cases, radical mastectomy + partial cholecystectomy in 1 case of hepatic duct jejunostomy. Two cases of surgery. 3 died and 8 survived. Conclusion The high risk factors of gallbladder carcinoma are emphasized. The intraoperative resection of the gallbladder and frozen section examination are performed. The conventional paraffin section examination after operation is helpful to find the unexpected gallbladder cancer. The gallbladder carcinoma radical operation Can extend the survival time and improve the prognosis.