摘要
目的探讨术后意外胆囊癌的处理对策。方法对78例术后胆囊癌进行回顾性临床病理分析,并就临床分期和预后与非意外胆囊癌组进行比较。结果78例术后意外胆囊癌,术前诊断以各类急、慢性胆囊炎、胆囊结石和胆囊息肉为主。77例行单纯胆囊切除术,1例行胆囊造瘘术。按UICC标准进行TNM分期,0期9例,Ⅰ期27例,Ⅱ期31例,Ⅲ期11例,无ⅣA和ⅣB期病例;意外胆囊癌组的肿瘤分期与非意外组相比,差异有统计学意义(P<0.0001)。意外胆囊癌组的预后也明显好于非意外组(P<0.01)。结论手术医师应提高对胆囊癌的警惕性。术中常规剖视胆囊,对可疑病变行冰冻切片检查。对T2～T4期的术后意外胆囊癌应宜再次剖腹做根治性手术,以改善预后。
Objective To explore the strategy for management of postoperative unsuspected gallbladder carcinoma. Methods The clinical data of 78 patients with postoperative unsuspected gallbladder carcinoma treated in Shanghai area were retrospectively analyzed. Meanwhile, its clinical classification and prognosis were compared with those of gallbladder carcinoma. Results The 78 cases were preoperatively diagnosed to mainly suffer from acute or chronic cholecystitis, gallstone or gallpolyp. Of the 78 patients, 77 underwent cholecystectomy and 1 gallbladder fistulation. Nine were of TNM stage 0, 27 stage Ⅰ , 31 stage Ⅱ , 11 stage Ⅲ. There was significant difference in the TNM staging between the postoperative unsuspected gallbladder carcinoma group and the gallbladder carcinoma group （P〈0.0001）. Meanwhile, the prognosis was better in the unsuspected group （P〈 0. 01）. Conclusions The surgeons should be alert during the operation. Routine examination of resected gallbladder tissue and frozen slicing of the tissue are necessary for suspected lesions. For postoperative unsuspected gallbladder carcinoma of T2 to T4, re-exploration and radical resection should be performed to achieve better prognosis.
出处
《中华肝胆外科杂志》
CAS
CSCD
2005年第9期601-603,共3页
Chinese Journal of Hepatobiliary Surgery
