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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2026, Vol. 15 ›› Issue (05) : 798 -805. doi: 10.3877/cma.j.issn.2095-3232.2026.05.016

临床研究

LC联合肝楔形切除术在术前高度疑似胆囊癌患者中的应用
王文超1, 王超群2, 朱文伟2, 陆录2, 汤旻1, 殷保兵2,†()   
  1. 1　200090　上海，同济大学附属杨浦医院普外科
    2　200040　上海，复旦大学附属华山医院肝胆外科
  • 收稿日期:2026-03-02 出版日期:2026-10-10
  • 通信作者: 殷保兵
  • 基金资助:
    上海市2024年度“科技创新行动计划”医学创新研究项目(24Y12800500)

Application of laparoscopic cholecystectomy combined with liver wedge resection in patients with preoperative highly-suspected gallbladder cancer

Wenchao Wang1, Chaoqun Wang2, Wenwei Zhu2, Lu Lu2, Min Tang1, Baobing Yin2,†()   

  1. 1 Department of General Surgery, Yangpu Hospital, Tongji University, Shanghai 200090, China
    2 Department of Hepatobiliary Surgery, Huashan Hospital Fudan University, Shanghai 200040, China
  • Received:2026-03-02 Published:2026-10-10
  • Corresponding author: Baobing Yin
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引用本文：

王文超, 王超群, 朱文伟, 陆录, 汤旻, 殷保兵. LC联合肝楔形切除术在术前高度疑似胆囊癌患者中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(05): 798-805.

Wenchao Wang, Chaoqun Wang, Wenwei Zhu, Lu Lu, Min Tang, Baobing Yin. Application of laparoscopic cholecystectomy combined with liver wedge resection in patients with preoperative highly-suspected gallbladder cancer[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2026, 15(05): 798-805.

目的

探讨术前高度疑似胆囊癌患者行腹腔镜胆囊切除术（LC）联合肝楔形切除术的可行性与安全性。

方法

回顾性分析2022年1月至2024年12月在复旦大学附属华山医院肝胆外科中心行LC联合肝楔形切除的20例术前高度疑似胆囊癌患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男11例，女9例；年龄29~88岁，中位年龄64岁。经积极术前评估和准备，行LC联合距离胆囊床周围2 cm肝组织楔形整块切除。观察手术及围术期恢复情况，分析术后病理资料和短期预后。

结果

所有患者手术顺利，无中转开腹，术中均无胆囊破裂及胆汁溢出。12例单纯行腹腔镜下胆囊联合肝楔形切除，手术时间（92±13） min，术中出血量70（50，105） ml；8例行LC联合肝楔形切除附加区域淋巴结清扫，手术时间（155±18） min，术中出血量170（135，200） ml。患者总住院时间（4.7±1.4）d。病理学检查显示，冰冻（-）/石蜡（-）患者8例，冰冻（+）/石蜡（+）患者8例，冰冻（-）/石蜡（+）患者4例。20例术前高度疑似胆囊癌患者最终石蜡切片病理学确诊胆囊癌12例，其中Tis期1例，T1a期2例，T1b期2例，T2a期5例，T2b期2例；其中血管侵犯1例，神经侵犯3例；所有患者胆囊管切缘均阴性；病理类型：胆囊腺癌7例，局部癌变3例，神经内分泌癌2例。根据冰冻及石蜡病理结果，采用了不同的附加手术方案：3例冰冻（-）/石蜡（+）的pTis/T1a期患者无附加手术；1例冰冻（-）/石蜡（+）的pT2a期患者于术后1个月行补救开腹肝段（S4b+S5）切除+区域淋巴结清扫术。8例冰冻（+）/石蜡（+）患者术中附加腹腔镜区域淋巴结清扫术，术后未行补救性手术。无围手术期死亡发生，除1例高龄患者术后发生肺部感染外，均未出现明显手术相关并发症。中位随访时间18.0（9.5，26.5）个月，随访期内均未见肿瘤复发转移和死亡。

结论

对于术前高度疑似胆囊癌患者，采用LC联合肝楔形切除的手术策略安全有效，可在不增加并发症的前提下有效避免术中肿瘤医源性播散及残留，减少复发种植，改善患者预后。

关键词: 腹腔镜, 胆囊癌, 胆囊切除术, 肝楔形切除
Objective

To evaluate the feasibility and safety of laparoscopic cholecystectomy (LC) combined with liver wedge resection in patients with preoperative highly-suspected gallbladder cancer.

Methods

Clinical data of 20 patients with preoperative highly-suspected gallbladder cancer who underwent LC combined with liver wedge resection in Department of Hepatobiliary Surgery, Huashan Hospital Fudan University from January 2022 to December 2024 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 11 patients were male and 9 female, aged from 29 to 88 years, with a median age of 64 (58, 72) years. After active preoperative evaluation and preparation, all patients underwent LC combined with liver wedge resection (en bloc) 2 cm from the gallbladder bed. Surgical condition and perioperative recovery were observed. Postoperative pathological data and short-term recurrence were analyzed.

Results

All operations were successfully performed without conversion to open surgery. No intraoperative gallbladder rupture or bile leakage occurred. 12 patients underwent LC combined with liver wedge resection. The mean operation time was (92±13) min and intraoperative blood loss was 70 (50, 105) ml. 8 patients underwent LC combined with liver wedge resection plus regional lymph node dissection. The mean operation time was (155±18) min and intraoperative blood loss was 170 (135, 200) ml. The length of hospital stay was (4.7±1.4) d. Pathological examination revealed 8 cases of frozen section (-)/paraffin section (+), 8 cases of frozen section (+)/paraffin section (+), and 4 cases of frozen (-)/paraffin (+), respectively. Among 20 patients with preoperative highly-suspected gallbladder cancer, pathological paraffin section confirmed gallbladder cancer in 12 patients, including Tis (n=1), T1a (n=2), T1b (n=2), T2a (n=5), and T2b (n=2). Vascular invasion was observed in 1 case and perineural invasion in 3 cases. Cystic duct margins were negative in all cases. Pathological types included 7 cases of gallbladder adenocarcinoma, 3 cases of focal carcinoma, and 2 cases of neuroendocrine carcinoma. Based on frozen and paraffin section results, different additional surgical procedures were performed: 3 pTis/T1a patients with frozen section (-)/paraffin section (+) received no additional surgery; 1 pT2a patient with frozen section (-)/paraffin section(+) underwent salvage open hepatic segmentectomy (S4b+S5) plus regional lymph node dissection at postoperative 1 month. 8 patients with frozen section (+)/paraffin section (+) received intraoperative laparoscopic regional lymph node dissection and no salvage surgery. No perioperative death occurred. 1 elderly patient developed postoperative pulmonary infection, and no significant postoperative complications were observed in the remaining cases. The median follow-up time was 18.0 (9.5, 26.5) months. No tumor recurrence, metastasis or death was observed during the follow-up.

Conclusions

For patients with highly-suspected gallbladder cancer, LC combined with liver wedge resection (en bloc) is a safe and effective procedure. It effectively avoids iatrogenic dissemination and tumor residue during surgery, reduces the risk of recurrence and implantation, and improves clinical prognosis without increasing complications.

Key words: Laparoscopy, Gallbladder neoplasms, Cholecystectomy, Hepatic wedge resection
图1 一例术前高度疑似胆囊癌患者影像学检查 注：a为MRI检查T1WI见胆囊底壁一大小约1.5 cm×1.0 cm混杂信号病灶；b为MRI检查T2WI表现为稍高信号；c为MRI增强扫描显示动脉期病灶强化明显；d为PET-CT示该病灶18F-FDG代谢异常升高；红色箭头示可疑病灶；18F-FDG为氟代脱氧葡萄糖
表1 20例高度疑似胆囊癌患者临床资料
例序 性别 年龄(岁) 影像学表现 冰冻病理 石蜡病理 手术时间(min) 术中出血量(ml) 术后并发症 住院时间(d) 随访时间(月)
1 男 76 胆囊底壁增厚，连续性显示欠清晰，PET-CT(+) (-) (-) 105 160 (-) 5.0 12
2 男 74 胆囊底壁增厚，强化明显，PET-CT(+) (-) (-) 85 150 (-) 5.5 12
3 男 46 占位，胆囊壁毛糙及强化，PET-CT(+) (-) (-) 95 110 (-) 4.5 18
4 男 29 胆囊体部占位伴明显强化 (-) (-) 90 80 (-) 3.0 19
5 女 48 胆囊体、底部壁局限性增厚伴强化，PET-CT(+) (-) (-) 80 50 (-) 5.0 9
6 男 60 胆囊底壁可疑增厚，PET-CT(+) (-) (-) 100 100 (-) 3.0 9
7 女 67 胆囊壁增厚伴明显强化，瓷化胆囊 (-) (-) 90 50 (-) 6.5 23
8 女 58 胆囊壁明显增厚，PET-CT(+) (-) (-) 110 60 (-) 5.0 18
9 女 62 胆囊体壁增厚伴明显强化 (-) (+) 75 40 (-) 2.0 42
10 男 51 胆囊腔内软组织肿块伴强化 (-) (+) 87 50 (-) 3.0 34
11 男 71 宽蒂病灶，强化明显，近期增大 (-) (+) 70 60 (-) 2.0 23
12 女 68 胆囊局部壁增厚，无蒂病灶伴强化 (-) (+) 112 80 (-) 4.0 9
13 女 78 胆囊底壁软组织病灶，PET-CT(+) (+) (+) 176 200 (-) 5.0 33
14 女 72 胆囊底壁增厚，软组织病灶伴明显强化，与周围肝脏界限模糊 (+) (+) 180 120 (-) 6.0 27
15 男 61 胆囊壁不规则增厚伴强化明显 (+) (+) 145 180 (-) 5.5 10
16 男 61 胆囊腔内软组织病灶伴不均匀强化，PET-CT(+) (+) (+) 150 200 (-) 5.0 32
17 男 58 胆囊壁异常信号伴不均匀强化 (+) (+) 138 200 (-) 5.0 9
18 女 65 胆囊底部占位，PET-CT(+) (+) (+) 157 160 (-) 6.5 9
19 男 88 胆囊底部占位伴不均匀强化，PET-CT(+) (+) (+) 130 100 肺部感染 7.0 26
20 女 66 胆囊底部软组织病灶，PET-CT(+) (+) (+) 165 150 (-) 5.0 14
表2 12例确诊胆囊癌患者的病理资料及手术方法
例序 病理组织学 附加手术
pT pN pM 胆囊管切缘 血管侵犯 神经侵犯 病理类型
9 T1a Nx M0 (-) (-) (-) 管状-乳头状腺瘤，局部癌变 无
10 T2a N1 M0 (-) (-) (-) 癌变，局灶区见黏液腺癌，中分化 开腹肝段(S4b+S5)切除+区域淋巴结清扫术
11 Tis Nx M0 (-) (-) (-) 绒毛状-管状腺瘤伴高级别上皮内瘤变，局部癌变 无
12 T1a Nx M0 (-) (-) (-) 黏液乳头状肿瘤，小灶区癌变，伴发低分化神经内分泌癌NEC/G3 无
13 T1b N0 M0 (-) (-) (-) 腺癌，中分化 腹腔镜区域淋巴结清扫术
14 T2a N0 M0 (-) (-) (-) 腺癌，中分化 腹腔镜区域淋巴结清扫术
15 T2a N0 M0 (-) (+) (+) 腺癌，中-低分化 腹腔镜区域淋巴结清扫术
16 T2b N0 M0 (-) (-) (-) 神经内分泌癌，小细胞性 腹腔镜区域淋巴结清扫术
17 T2b N0 M0 (-) (-) (-) 腺癌，低分化，小灶区伴有鳞状分化 腹腔镜区域淋巴结清扫术
18 T1b N0 M0 (-) (-) (-) 腺上皮高级别上皮内瘤变，局部癌变 腹腔镜区域淋巴结清扫术
19 T2a N0 M0 (-) (-) (+) 腺癌，中分化 腹腔镜区域淋巴结清扫术
20 T2a N0 M0 (-) (-) (+) 腺癌，中-低分化 腹腔镜区域淋巴结清扫术
图2 术前高度疑似胆囊癌行腹腔镜胆囊切除术联合肝楔形切除的诊疗策略
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