Objective:To summarize the clinical and pathological characteristics of unexpected gallbladder carcinoma (UGC)in laparoscopic cholecystectomy ( LC), and investigate the operative methods and strategies for the prevention of metastasis and recurrence. Methods:Between Aug. 1997 and Nov. 2008,26 UGC patients were discovered among 5 586 cases of LC. A retrospective study was performed based on the clinical data of these patients. The cumulative survival rate between simple cholecystectomy group and radical operation for gallbladder carcinoma group, pTis, pT1 patients and pT2, pT3, pT4 patients were compared by Kaplan-Meier analysis.Results: All the preoperative tentative diagnosis of 26 cases was benign disease,including cholecystolithiasis and gallbladder polyp. According to pathologic T stage,two cases were on the stage of pTis,4 on pT1a ,3 on pT1b ,10 on pT2 ,5 on pT3 and 2 on pT4. The cumulative survival rate of radical operation for gallbladder carcinoma group was better than that of simple chotecystectomy group ;The prognosis of patients on stages pTis and pT1 were better than those who were on stages pT2, pT3 and pT4. Conclusions: Attention should be paid to the high risk population. The preoperative clinical data of patients should be analyzed roundly, the gallbladder should be examined carefully during operation, and frozen section examination for the specimen should be done. Once the diagnosis is confirmed, standard radical resection should be performed in early stage, and the effective measures should be taken to avoid tumor implantation and metastasis.%目的:总结腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中意外胆囊癌(unexpected gallbladder carcinoma,UGC)的临床病理特点,探讨手术方法及预防转移复发的对策.方法:回顾分析1997年8月至2008年11月5 586例LC术中26例(0.47%)UGC患者的临床资料,应用Kaplan-Meier法对比单纯胆囊切除术组、胆囊癌根治术组及pTis、pT1期与pT2、pT3、pT4期患者的累积生存率.结果:26例UGC患者中,术前诊断以胆囊结石和胆囊息肉为主.按病理分期,pTis期2例,pT1a期4例,pT1b期3例,pT2期10例,pT3期5例,pT4期2例.胆囊癌根治组患者累积生存率优于单纯胆囊切除组;pTis、pT1期患者预后显著优于pT2、pT3、pT4期.结论:具有胆囊癌高危因素的患者,术前应全面分析临床资料,术中仔细剖检胆囊,标本行冰冻切片检查,一旦确诊应早期行根治性切除术,术中需采取措施预防肿瘤种植和转移.
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