摘要
根治性手术是胆囊癌(GBC)唯一可能治愈的方式。在精准外科理念的指导下,基于胆囊癌AJCC TNM分期,合理选择手术治疗策略,对改善病人预后具有重要意义。对于0期与T1a期胆囊癌,只要术中胆囊完整无破损、胆囊管切缘阴性,单纯的胆囊切除就可以实现根治切除。对于T1b、T2期胆囊癌,为了实现根治性切除术,需要根据T分期确定肝切除范围,并联合肝十二指肠韧带淋巴结清扫。对于意外胆囊癌,病理证实T1b期以上,需尽早追加根治性手术。然而GBC分期越晚,有关是否手术以及手术方式的争议越多。近年来,随着微创技术的快速发展、机器人手术的逐步推广,GBC腹腔镜手术治疗正逐步摆脱手术技术的限制,治疗效果逐渐被临床医生认可。虽然如此,腹腔镜手术治疗GBC仍不被列入治疗标准,尚需持谨慎态度。
Radical surgery is the only curative method for gallbladder carcinoma(gallbladder carcinoma,GBC).Under the guidance of precision surgery concept,the reasonable selection of surgical strategy is of great significance to improve the prognosis of patients based on AJCC TNM staging of GBC.For stage 0 and stage T1a GBC,radical resection could be achieved as long as the gallbladder is intact and the surgical margin of the cystic duct is negative.For stage T1b and T2 GBC,in order to achieve radical resection,the extent of hepatectomy should be determined according to T staging and lymph node dissection of hepatoduodenal ligament should be done.For incidental GBC which is pathologically confirmed as stage T1b or above,it is necessary to perform a radical operation as soon as possible.However,depending on the staging of GBC,there were more controversies about the timing and extent of re-operation.In recent years,with the rapid development of minimally invasive technology and the promotion of robot surgery,laparoscopic treatment of GBC is gradually getting rid of the limitations of surgical technology,and the therapeutic effect is gradually recognized by clinicians.Nevertheless,laparoscopic surgery for GBC has not been the standardized treatment and needs to be with caution.
作者
戴朝六
鞠明光
Dai Chaoliu;Ju Mingguang(Department of Hepatobiliary and Splenic Surgery,Shengjing Hospital,China Medical University,Liaoning 110004,China)
出处
《中华普外科手术学杂志（电子版）》
2020年第3期224-227,共4页
Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)
基金
辽宁省重点研发计划指导计划项目(2017225032)
国家自然科学基金项目(81701570)。
关键词
胆囊肿瘤
腹腔镜手术
根治性手术
Gallbladder neoplasms
Laparoscopic surgery
Radical surgery
