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| 1 | Incidental gallbladder cancer during laparoscopic cholecystectomy:Managing an unexpected finding显示文摘AIM:To evaluate the impact of incidental gallbladder cancer on surgical experience.METHODS:Between 1998 and 2008 all cases of cholecystectomy at two divisions of general surgery,one university based and one at a public hospital,were retrospectively reviewed.Gallbladder pathology was diagnosed by history,physical examination,and laboratory and imaging studies [ultrasonography and computed tomography(CT)].Patients with gallbladder cancer(GBC) were further analyzed for demographic data,and type of operation,surgical morbidity and mortality,histopathological classification,and survival.Incidental GBC was compared with suspected or preoperatively diagnosed GBC.The primary endpoint was diseasefree survival(DFS).The secondary endpoint was the difference in DFS between patients previously treated with laparoscopic cholecystectomy and those who had oncological resection as first intervention.RESULTS:Nineteen patients(11 women and eight men) were found to have GBC.The male to female ratio was 1:1.4 and the mean age was 68 years(range:45-82 years).Preoperative diagnosis was made in 10 cases,and eight were diagnosed postoperatively.One was suspected intraoperatively and confirmed by frozen sections.The ratio between incidental and nonincidental cases was 9/19.The tumor node metastasis stage was:pTis(1),pT1a(2),pT1b(4),pT2(6),pT3(4),pT4(2);five cases with stageⅠa(T1 a-b);two with stageⅠb(T2 N0);one with stage Ⅱa(T3 N0);six with stage Ⅱb(T1-T3 N1);two with stage Ⅲ(T4 Nx Nx);and one with stage Ⅳ(Tx Nx Mx).Eighty-eight percent of the incidental cases were discovered at an early stage(≤Ⅱ).Preoperative diagnosis of the 19 patients with GBC was:GBC with liver invasion diagnosed by preoperative CT(nine cases),gallbladder abscess perforated into hepatic parenchyma and involving the transversal mesocolon and hepatic hilum(one case),porcelain gallbladder(one case),gallbladder adenoma(one case),and chronic cholelithiasis(eight cases).Every case,except one,with a T1b or more advanced invasion underwent Ⅳb + Ⅴ wedge liver resection and pericholedochic/hepatoduodenal lymphadenectomy.One patient with stage T1b GBC refused further surgery.Cases with Tis and T1a involvement were treated with cholecystectomy alone.One incidental case was diagnosed by intraoperative frozen section and treated with cholecystectomy alone.Six of the nine patients with incidental diagnosis reached 5-year DFS.One patient reached 38 mo survival despite a port-site recurrence 2 years after original surgery.Cases with non incidental diagnosis were more locally advanced and only two patients experienced 5-year DFS.CONCLUSION:Laparoscopic cholecystectomy does not affect survival if implemented properly.Reoperation should have two objectives:R0 resection and clearance of the lymph nodes. | Andrea Cavallaro Gaetano Piccolo Vincenzo Panebianco Emanuele Lo Menzo Massimiliano Berretta Antonio Zanghì Maria Di Vita Alessandro Cappellani | 2012 | World Journal of Gastroenterology2012，18，30： | 33 |
| 2 | 意外胆囊癌行腹腔镜根治术的可行性显示文摘意外胆囊癌(unsuspected/unexpected incidental gallbladdercarcinoma,UGC)是一种术前检查诊断为良性胆囊疾病,如囊息肉、胆囊结石、急慢性胆囊炎等,而在术中或术后病理证实为胆囊癌的疾病。腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中和术后发现的UGC约有0.2%~2.1%,近年来随着LC的广泛开展,UGC的比率正逐年升高,约占胆囊癌患者的50%~58%。 | 马强 王许安 刘颖斌 | 2017 | 中华普通外科杂志2017，32，5： | 9 |
| 3 | 扩大根治术用于中晚期胆囊癌的疗效及安全性分析显示文摘目的探讨扩大根治术用于治疗中晚期胆囊癌的疗效及安全性。方法将60例中晚期胆囊癌患者根据手术方式的不同分为标准根治术13例,扩大根治术20例,姑息性手术19例,剖腹探查术8例。观察不同术式的并发症。采用电话和门诊随访2年,比较不同术式患者的1年和2年生存率。结果标准根治术、扩大根治术、姑息性手术和剖腹探查术的并发症发生率分别为7.7%、20.0%、10.5%和0.0%。Ⅲ期、Ⅳ期患者的的中位生存时间分别为6个月和5个月。Ⅲ期、Ⅳ期患者的1年和2年生存率分别为30.8%、15.4%,6.4%、4.3%。不同分期的胆囊癌患者生存率比较,差异无统计学意义(χ~2=0.255,P=0.133)。扩大根治术患者Ⅲ期和Ⅳ期的中位生存时间为12个月和10个月。在Ⅲ、Ⅳ期胆囊癌患者中,行不同术式患者生存率之间差异有统计学意义(χ~2=10.036,P=0.018;χ~2=15.829,P=0.001)。结论胆囊癌扩大根治术治疗中晚期胆囊癌可显著延长患者术后生存时间,但并发症发生率较高。临床上施行胆囊癌扩大根治术治疗中晚期胆囊癌时应严格遵循手术适应证。 | 魏强 赵海荣 张阁 康昭 | 2017 | 实用癌症杂志2017，32，10： | 8 |
| 4 | 不同手术方式治疗中晚期胆囊癌的生存分析显示文摘目的:评价不同手术方式对中晚期胆囊癌患者生存的影响。方法:回顾性分析2000年1月—2009年12月接受不同手术方式治疗的72例中晚期胆囊癌患者,包括胆囊癌扩大根治术20例、姑息性切除术13例、单纯胆管内或胆管外引流术25例以及剖腹探查术14例,比较不同手术方式治疗组患者的术后并发症和生存情况。结果:66例患者获得随访,其中胆囊癌扩大根治术19例,姑息性切除术13例,单纯胆管内或胆管外引流术22例,剖腹探查术12例。胆囊癌扩大根治术后的中位生存时间(12个月)明显优于姑息性切除术(4个月)、单纯胆管内或胆管外引流术(2个月)或剖腹探查术(3个月),差异有统计学意义(P<0.05)。胆囊癌扩大根治术后的1年和2年生存率分别为52.6%和26.3%,姑息性切除术后的1年和2年生存率分别为7.7%和0.0%,单纯胆管内或胆管外引流术后的1年和2年生存率分别为4.5%和0.0%,剖腹探查术后的1年和2年生存率均为0.0%。胆囊癌扩大根治术后的1年和2年生存率均明显高于其余3种手术方式(P<0.05)。20例接受胆囊癌扩大根治术的患者中,有6例发生术后并发症。结论:胆囊癌扩大根治术与姑息性切除术、单纯胆管内或胆管外引流术以及剖腹探查术相比,可显著延长患者的术后生存时间。应当考虑在中晚期胆囊癌患者中严格筛选合适病例以实施胆囊癌扩大根治术,并积极预防术后并发症。 | 宋燕州 王瑞涛 许鑫森 魏吉超 刘昌 | 2012 | 肿瘤2012，32，10： | 8 |
| 5 | 胆囊癌扩大根治术的范围、术式选择与评价显示文摘胆囊癌是胆道系统常见的恶性肿瘤,且近年来有发病率上升、发病年龄下降的趋势。其病因不明,早期诊断困难,恶性程度高,易发生转移和复发,为手术治疗的难点。本文就国内外在胆囊癌扩大根治术方面的进展作简要综述,重点讨论其切除范围及并发症的防治。 | 蒙轩 张太平 何小东 赵玉沛 | 2011 | 国际外科学杂志2011，38，8： | 6 |
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