临床研究(Clinical Research)

腹腔镜胆囊切除术后常规病理检查的必要性探讨

Published at: 2015年第24卷第8期

曹贵章 1 , 邓毅磊 2 , 吴昊钧 2
1 青海省交通医院 普通外科,青海 西宁 810000
2 四川大学华西医院 胆道外科,四川 成都 610041
通讯作者 贵章 曹 Email: caoguizhang1980@163.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2015.08.017
基金:

摘要

目的:探讨腹腔镜胆囊切除术(LC)后胆囊常规病理检查的必要性。方法:搜集华西医院病理科5 年间的全部胆囊病理报告,找出其中LC 术后意外胆囊癌患者,并分析其临床资料。结果:LC 术后意外胆囊癌的发生率约为0.28%(36/12 969),88.9%(32/36)为腺癌,58.3%(21/36)为原位癌和早期胆囊癌(T1a 和T1b)。结合术前影像学检查,术中通过观察及胆囊标本触摸,成功辨认出34 例(94.4%)意外胆囊癌患者存在的可疑病变,遗漏1 例原位癌和1 例T1a 期患者。结论:绝大多数意外胆囊癌患者均可在术中发现可疑病变,极少数肿瘤处于极早期无法发现者,单纯的胆囊切除已达有效治疗。因此,LC 术后常规的行胆囊病理检查的必要性有待商榷。


Is routine pathological examination of gallbladder necessary after laparoscopic cholecystectomy?

Abstract

Objective: To assess the necessity of routine pathological examination of the gallbladder after laparoscopic cholecystectomy (LC). Methods: All pathological reports of gallbladder over a 5-year period in Department of Pathology of West China Hospital were collected to pick up the cases of incidental gallbladder cancer after LC, and then their clinical data were analyzed. Results: The incidence of incidental gallbladder cancer after LC was 0.28% (36/12 969), among which, 89% (32/36) were adenocarcinoma, and 58.3% carcinoma in situ (Tis) and early gallbladder cancer (T1a and T1b). A suspicious lesion was successfully identified in 34 patients (94.4%) during operation, through intraoperative observation and palpation of the gallbladder specimen combined with preoperative imaging findings, and one Tis case and one T1a case missed identification. Conclusion: A suspicious lesion can be found during operation in a great majority of cases of incidental gallbladder cancer, only a very few cases in very early stages are difficult to be identified, and for these cases, simple cholecystectomy can offer adequate effectiveness. So, the necessity of routine pathological examination of the gallbladder after LC is still questionable.


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引用

引用本文: 贵章 曹, 毅磊 邓, 昊钧 吴. 腹腔镜胆囊切除术后常规病理检查的必要性探讨[J]. 中国普通外科杂志, 2015, 24(8): 1140-1144.
Cite this article as: CAO Guizhang, SHRESTHA Anuj, WU Haojun . Is routine pathological examination of gallbladder necessary after laparoscopic cholecystectomy?[J]. Chin J Gen Surg, 2015, 24(8): 1140-1144.