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中华普通外科学文献(电子版) ›› 2022, Vol. 16 ›› Issue (06) : 448 -451. doi: 10.3877/cma.j.issn.1674-0793.2022.06.015

综述

意外胆囊癌外科治疗进展与争议
刘伟1, 王亚军1, 王永兴1,()   
  1. 1. 010051 呼和浩特,中国人民解放军联勤保障部队第九六九医院普通外科
  • 收稿日期:2022-05-28 出版日期:2022-12-01
  • 通信作者: 王永兴

Advance and controversy on surgical treatment of incidental gallbladder carcinoma

Wei Liu1, Yajun Wang1, Yongxing Wang1,()   

  1. 1. Department of General Surgery, the 969th Hospital of the Joint Logistics Support Force of the Chinese People’s Liberation Army, Hohhot 010051, China
  • Received:2022-05-28 Published:2022-12-01
  • Corresponding author: Yongxing Wang
引用本文:

刘伟, 王亚军, 王永兴. 意外胆囊癌外科治疗进展与争议[J]. 中华普通外科学文献(电子版), 2022, 16(06): 448-451.

Wei Liu, Yajun Wang, Yongxing Wang. Advance and controversy on surgical treatment of incidental gallbladder carcinoma[J]. Chinese Archives of General Surgery(Electronic Edition), 2022, 16(06): 448-451.

胆囊癌早期缺乏特异性的临床表现、生物学指标及影像特征,故临床极易出现漏诊。针对存在胆囊癌高危因素的患者,在早期采取适宜、必要的检查手段有助于提高意外胆囊癌的检出率。根治性手术是T1b-T3期意外胆囊癌最有效的治疗方法,但对于不同肿瘤分期手术切除范围、手术方式及二次手术时机、是否常规切除戳孔等尚存在较大争议。腹腔镜技术仅限于早期患者的探索性研究,对于进展期意外胆囊癌患者仍建议开腹手术。

Incidental gallbladder carcinoma is probably misdiagnosed at early stage due to the lack of unique clinical symptoms, biochemistry and imaging features. Appropriate and essential examinations can improve the preoperative diagnosis rate for patients with high risk of gallbladder carcinoma in clinical practice. Radical resection is considered as the most effective procedure for incidental gallbladder carcinoma with T1b-T3 diseases because of the superior survival, but there remains some controversies about the scope of resection according to different tumor stages, the types of surgical access, the timing of reoperation and whether to remove the port-site routinely. Open surgery is recommended in cases of advanced gallbladder carcinoma, and laparoscopic procedure is just suggested for exploratory study in patients at early stage.

[1]
Marcial-Rojas RA, Medina R. Unsuspected carcinoma of the gallbladder in acute and chronic cholecystitis[J]. Ann Surg, 1961, 153(2): 289-298.
[2]
Pyo JS, Son BK, Lee HY, et al. Incidental carcinoma after cholecystectomy for benign disease of the gallbladder: A meta-analysis[J]. J Clin Med, 2020, 9(5): 1484.
[3]
孙旭恒,王一钧,张薇, 等. 中国胆囊癌流行病学特征与诊治及预后分析(附6 159例报告)[J]. 中华消化外科杂志, 2022, 21(1): 114-128.
[4]
Choi KS, Choi SB, Park P, et al. Clinical characteristics of incidental or unsuspected gallbladder cancers diagnosed during or after cholecystectomy: A systematic review and meta-analysis[J]. World J Gastroenterol, 2015, 21(4): 1315-1323.
[5]
沈盛,锁涛. 意外胆囊癌发生原因及防治策略[J/CD]. 中华肝脏外科手术学电子杂志, 2020, 9(1): 22-25.
[6]
中华医学会外科学分会胆道外科学组,中国医师协会外科医师分会胆道外科专业委员会. 胆囊癌诊断和治疗指南(2019版)[J]. 中华外科杂志, 2020, 58(4): 243-251.
[7]
张标,陈旭,袁启航, 等. 意外胆囊癌的预防与外科处理[J]. 肝胆胰外科杂志, 2021, 33(5): 257-262.
[8]
袁波,傅晓辉,尹磊, 等. 联合检测肿瘤标志物对胆囊癌诊断及患者预后的价值[J]. 中华肝胆外科杂志, 2019, 25(10): 746-750.
[9]
王向,张永杰. 意外胆囊癌的治疗现状与展望[J]. 肝胆胰外科杂志, 2020, 32(11): 646-651.
[10]
de Savornin Lohman E, van der Geest LG, de Bitter T, et al. Re-resection in incidental gallbladder cancer: survival and the incidence of residual disease[J]. Ann Surg Oncol, 2020, 27(4): 1132-1142.
[11]
Yuza K, Sakata J, Prasoon P, et al. Long-term outcomes of surgical resection for T1b gallbladder cancer: An institutional evaluation[J]. BMC Cancer, 2020, 20(1): 20.
[12]
刘鹏,张贤彬,耿智敏, 等. 不同手术方式治疗T1b期胆囊癌效果的多中心研究[J]. 中华外科杂志, 2018, 56(5): 355-359.
[13]
Hari DM, Howard JH, Leung AM, et al. A 21-year analysis of stage I gallbladder carcinoma: is cholecystectomy alone adequate?[J]. HPB (Oxford), 2013,15(1): 40-48.
[14]
Mazer LM, Losada HF, Chaudhry RM, et al. Tumor characteristics and survival analysis of incidental versus suspected gallbladder carcinoma[J]. J Gastrointest Surg, 2012,16(7): 1311-1317.
[15]
Vo E, Curley SA, Chai CY, et al. National failure of surgical staging for T1b gallbladder cancer[J]. Ann Surg Oncol, 2019, 26(2): 604-610.
[16]
Goetze TO, Paolucci V. Benefits of reoperation of T2 and more advanced incidental gallbladder carcinoma: analysis of the German registry[J]. Ann Surg, 2008, 247(1): 104-108.
[17]
Isambert M, Leux C, Métairie S, et al. Incidentally-discovered gallbladder cancer: when, why and which reoperation?[J]. J Visc Surg, 2011, 148(2): e77-e84.
[18]
Ethun CG, Postlewait LM, Le N, et al. Association of optimal time interval to re-resection for incidental gallbladder cancer with overall survival: A multi-institution analysis from the US extrahepatic biliary malignancy consortium[J]. JAMA Surg, 2017, 152(2): 143-149.
[19]
Agopian VG, Hiatt JR. The timing of reoperation for incidental gallbladder cancer: sooner or later?[J]. JAMA Surg, 2017, 152(2): 149.
[20]
Du J, Yang XW, Wen ZJ, et al. Relationship between prognosis and time interval from cholecystectomy to reoperation in postoperative incidental gallbladder carcinoma[J]. Chin Med J (Engl), 2018, 131(20): 2503-2505.
[21]
Zhang W, Che X. Feasibility and safety of laparoscopic treatment for early and T3 stage gallbladder cancer: A systematic review[J]. Surg Laparosc Endosc Percutan Tech, 2020, 31(1): 113-123.
[22]
Dou C, Zhang Y, Liu J, et al. Laparoscopy versus laparotomy approach of a radical resection for gallbladder cancer: A retrospective comparative study[J]. Surg Endosc, 2020, 34(7): 2926-2938.
[23]
Gao KJ, Yan ZL, Yu Y, et al. Port-site metastasis of unsuspected gallbladder carcinoma with ossification after laparoscopic cholecystectomy: A case report[J]. World J Clin Cases, 2020, 8(22): 5729-5736.
[24]
Berger-Richardson D, Chesney TR, Englesakis M, et al. Trends in port-site metastasis after laparoscopic resection of incidental gallbladder cancer: A systematic review[J]. Surgery, 2017, 161(3): 618-627.
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