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中华普外科手术学杂志(电子版) ›› 2020, Vol. 14 ›› Issue (03) : 221 -223. doi: 10.3877/cma.j.issn.1674-3946.2020.03.002

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腹腔镜术中意外胆囊癌的诊断与处理策略
蔡建强1,(), 黄振1, 张业繁1, 胡翰杰1   
  1. 1. 100021 中国医学科学院肿瘤医院肝胆外科
  • 收稿日期:2019-11-14 出版日期:2020-06-26
  • 通信作者: 蔡建强

Diagnosis and therapeutic strategies of incidental gallbladder cancer in laporoscopic cholecystectomy

Jianqiang Cai1,(), Zhen Huang1, Yefan Zhang1, Hanjie Hu1   

  1. 1. National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100021
  • Received:2019-11-14 Published:2020-06-26
  • Corresponding author: Jianqiang Cai
  • About author:
    Corresponding author: Cai Jianqiang, Email:
  • Supported by:
    The CAMS Innovation Fund for Medical Sciences (CIFMS)(2016-I2M-1-001 and 2017-12M-4-002)
引用本文:

蔡建强, 黄振, 张业繁, 胡翰杰. 腹腔镜术中意外胆囊癌的诊断与处理策略[J/OL]. 中华普外科手术学杂志(电子版), 2020, 14(03): 221-223.

Jianqiang Cai, Zhen Huang, Yefan Zhang, Hanjie Hu. Diagnosis and therapeutic strategies of incidental gallbladder cancer in laporoscopic cholecystectomy[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2020, 14(03): 221-223.

意外胆囊癌是指术前诊断为良性病变,但是在胆囊单纯切除术中或术后病理诊断的胆囊癌,在腹腔镜胆囊切除中这种情况时有发生。提高术前影像诊断准确率可以减少意外胆囊癌发生率,准确的术中快速冰冻病理切片检查能够有效避免二次手术。病理诊断T分期为T1a及Tis期的意外胆囊癌患者,单纯胆囊切除术即可达到根治要求,无需二次手术。而T1b及更高T分期的意外胆囊癌患者,需要接受二次手术。二次手术的手术范围参照胆囊根治性切除的要求,也可以根据T分期来决定肝脏的切除范围和淋巴结清扫范围。

Incidental gallbladder cancer refers to pathologically confirmed gallbladder cancer during or after cholecystectomy. More accurate preoperative imaging diagnosis could effectively improve the diagnosis rate of gallbladder cancer, and intraoperative rapid frozen pathological examination helps to avoid the re-operation. For patients with T1a and Tis staging accidental gallbladder cancer, cholecystectomy could achieve radical effect. For patients with T1b or more late staging gallbladder cancer, radical re-operation is very important, and it is necessary to determine the extent of liver resection and lymph node dissection according to the staging of gallbladder cancer.

[1]
Hueman MT, Vollmer CM Jr, Pawlik TM,et al.Evolving treatment strategies for gall-bladder cancer[J]. Ann Surg Oncol,2009,16(8):2101-2115.
[2]
Basak F, Hasbahceci M, Canbak T, et al.Incidental findings during routine pathological evaluation of gallbladder specimens: review of 1,747 elective laparoscopic cholecystectomy cases[J]. Ann R Coll Surg Engl,2016,98(4):280-283.
[3]
Kalita D, Pant L, Singh S, et al.Impact of routine histopathological examination of gall bladder specimens on early detection of malignancy-a study of 4,115 cholecystectomy specimens[J]. Asian Pac J Cancer Prev,2013,14(5):3315-3318.
[4]
Clemente G, Nuzzo G, De Rose AM, et al.Unexpected gallbladder cancer after laparoscopic cholecystectomy for acute cholecystitis: a worrisome picture[J]. J Gastrointest Surg,2012,16(8):1462-1468.
[5]
Ghimire P, Yogi N, Shrestha BB.Incidence of incidental carcinoma gall bladder in cases of routine cholecystectomy[J]. Kathmandu Univ Med J (KUMJ),2011,9(34):3-6.
[6]
Shukla PJ, Barreto G, Neve R,et al.Can we do better than incidental gallbladder cancer? [J]. Hepatogastroenterology,2007,54(80):2184-2185.
[7]
Goodman MT, Yamamoto J.Descriptive study of gall-bladder, extrahepatic bile duct, and ampullary cancers in the United States, 1997-2002[J]. Cancer Causes Control,2007,18(4):415-422.
[8]
Firat YD, Idiz UO, Cakir C, et al.Prospective multi-center study of surgeon’s assessment of the gallbladder compared to histopathological examination to detect incidental malignancy[J]. Langenbecks Arch Surg,2019, 404:573-579.
[9]
Glenn F.Radical cholecystectomy for carcinoma of the gallbladder. In: Glenn, F. (ed.) Atlas of Biliary Tract Surgery[J]. The Macmillan Company, New York (1963).
[10]
Glenn F, Hays DM.The scope of radical surgery in the treatment of malignant tumors of the extrahepatic biliary tract[J]. Surg Gynecol Obstet,1954,99(5):529-541.
[11]
Yi X, Long X, Zai H,et al.Unsuspected gallbladder carcinoma discovered during or after cholecystectomy:focus on appropriate radical re-resection according to the T-stage[J]. Clin Transl Oncl,2013,15(8):652-658.
[12]
Matsumoto Y, Fujii H, Aoyama H,et al.Surgical treatment of primary carci-noma of the gallbladder based on the histologic analysis of 48 surgical specimens[J]. Am J Surg,1992,163(2):239-245.
[13]
Lundgren L, Muszynska C, Ros A,et al.Management of incidental gallbladder cancer in a national cohort[J]. Br J Surg,2019,106(9):1216-1227.
[14]
Hu L, Wang B, Liu X,et al.Unsuwpected gallbladder cancer:a clinical retrospective study[J].Arch Iran Med,2013,16(11):631-635.
[15]
Donohue JH, Nagorney DM, Grant CS,et al.Carcinoma of the gallbladder. Does radical resection improve outcome? [J].Arch Surg,1990,125(2):237-241.
[16]
Foster JM, Hoshi H, Gibbs JF,et al.Gallbladder cancer: defining the indications for primary radical resection and radical reresection[J]. Ann Surg Oncol,2007,14(2):833-840.
[17]
Shirai Y, Yoshida K, Tsukada K,et al.Radical surgery for gallbladder carcinoma. Long-term results[J]. Ann Surg,1992,216(5):565-568.
[18]
Shukla PJ, Barreto G, Kakade A,et al.Revision surgery for gallbladder cancer: factors influencing operability and further evidence for T1b tumours[J]. HPB (Oxford),2008,10(1):43-47.
[19]
Pawlik TM, Gleisner AL, Vigano L,et al.Incidence of finding resid-ual disease for incidental gallbladder carcinoma: implica-tions for re-resection[J]. J Gastrointest Surg,2007,11(11),1478-1486.
[20]
Fong Y, Jarnagin, W, Blumgart LH.Gallbladder cancer: comparison of patients presenting initially for definitive operation with those presenting after prior noncurative intervention[J]. Ann Surg,2000,232(4):557-569.
[21]
Horkoff MJ, Ahmed Z, Xu Y,et al.Adverse Outcomes After Bile Spillage in Incidental Gallbladder Cancers: A Population-based Study[J]. Ann Surg,2019.[Epub ahead of print]
[22]
中华医学会外科学分会胆道外科学组.胆囊癌诊断和治疗指南( 2015版) [J].临床肝胆病杂志,2016,32(3):411-419.
[23]
Japanese Society of Biliary Surgery: Classification of Biliary Tract Carcinoma[J]. Kanehara & Co, Tokyo (2004)
[24]
Shirai Y, Yoshida K, Tsukada K,et al.Identification of the regional lymphatic system of the gallbladder by vital staining[J]. Br J Surg,1992,79)7):659-662.
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