摘要
目的探讨意外胆囊癌(IGBC)的诊断与治疗。方法回顾性分析2013年1月至2018年3月在甘肃省人民医院行腹腔镜胆囊切除术(LC)的27例IGBC患者临床资料。其中男4例,女23例;年龄38~83岁,中位年龄62岁。术前诊断为胆囊结石24例,胆囊息肉3例。患者均签署知情同意书,符合医学伦理学规定。分析IGBC的临床特征和诊治方法。生存分析采用Log-rank检验。结果同期行LC的患者共6585例,IGBC占0.41%(27/6585),其中术中检出3例,术后检出24例;其中Tis期7例,T1b期3例,T2a期4例,T3期12例,T4期1例。术中检出3例均一期行胆囊癌根治术,10例二期行胆囊癌根治术。Tis、T1、T2、T3+T4期患者中位生存期分别为45、45、13、9个月,行胆囊癌根治术与非胆囊癌根治术患者中位生存期分别为32、17个月,不同肿瘤分期及手术方式的患者间生存差异有统计学意义(χ^2=21.061,4.440;P<0.05)。结论术中病理检查有利于IGBC及早发现,提供优化首次手术方案的机会,避免二次手术。IGBC患者预后与手术方式、病理分期密切相关。
Objective To investigate the diagnosis and treatments of incidental gallbladder cancer(IGBC).Methods Clinical data of 27 IGBC patients undergoing laparoscopic cholecystectomy(LC)in Gansu Provincial Hospital from January 2013 to March 2018 were retrospectively analyzed.Among them,4 patients were male and 23 female,aged from 38 to 83 years with a median age of 62 years.24 patients were diagnosed with gallbladder stones and 3 cases of gallbladder polyp before oprtation.The informed consents of all patients were obtained and the local ethical committee approval was received.The clinical characteristics,diagnosis and treatments of IGBC were analyzed.Survival analysis was performed by Log-rank test.Results A total of 6585 patients underwent LC in the same period,and IGBC accounted for 0.41%(27/6585).3 cases were diagnosed with IGBC during the operation and 24 cases after the operation.Among them,7 cases were diagnosed with IGBC Tis stage,and 3 with T1b,4 with T2a,12 with T3 and 1 with T4.The 3 patients who were diagnosed during the operation underwent radical resection of IGBC simultaneously and 10 cases received radical resection of IGBC in secondary operation.The median survival time of patients with Tis,T1,T2 and(T3+T4)stage IGBC was 45,45,13 and 9 months,respectively.The median survival time of patients undergoing radical resection and non-radical resection was 32 and 17 months.The survival time significantly differed between patients with different tumor stages and surgical approach(χ^2=21.0614.440;P<0.05).Conclusions Intraoperative pathological examination contributes to early detection of IGBC,provides an opportunity to optimize the primary surgical plan and avoids the secondary operation.Clinical prognosis of IGBC patients is significantly correlated with surgical approach and pathological stage.
作者
董晓骅
杨晓军
Dong Xiaohua;Yang Xiaojun(School of Clinical Medicine,Ningxia Medical University,Yinchuan 750000,China;DepartmentⅡof General Surgery,Gansu Provincial Hospital,Lanzhou 73000,China)
出处
《中华肝脏外科手术学电子杂志》
CAS
2020年第1期41-45,共5页
Chinese Journal of Hepatic Surgery(Electronic Edition)
基金
国家自然科学基金(81660398)。
关键词
胆囊肿瘤
胆囊切除术
腹腔镜
预后
Gallbladder neoplasms
Cholecystectomy,laparoscopic
Prognosis
