中国普通外科杂志2025，Vol.34Issue(2)：202-214,13.DOI:10.7659/j.issn.1005-6947.240582
意外胆囊癌延迟根治术的进展与思考:3D腹腔镜PH路径的临床应用
Progress and considerations in delayed radical surgery for incidental gallbladder cancer:clinical application of 3D laparoscopic PH approach
摘要
Abstract
Incidental gallbladder cancer(IGC)is a type of gallbladder cancer identified during or after cholecystectomy for benign gallbladder diseases through intraoperative or postoperative pathological examination.Since gallbladder cancer often coexists with benign conditions such as gallstones and polyps,and routine abdominal ultrasound has limited sensitivity in early diagnosis,IGC accounts for more than two-thirds of all gallbladder cancer cases.To improve early diagnosis rates,high-risk patients should undergo high-resolution ultrasound after surgery,combined with the use of radiomics and molecular biomarkers to reduce misdiagnosis and missed diagnoses.Most IGC patients are diagnosed at early stages,with a high incidence of residual disease.Delayed radical surgery can effectively improve prognosis.However,for patients with locally advanced disease,radical surgery should not be performed indiscriminately,and conversion surgery may be a better option.The optimal timing for delayed radical surgery is within 2 to 8 weeks after the initial surgery,with specific timing based on the resolution of acute inflammation and the evaluation of tumor staging and metastasis.For patients with T1b and T2 stage cancer,liver segment IVb/V resection and lymph node dissection are recommended to ensure curative outcomes.The application of laparoscopic techniques in gallbladder cancer treatment is becoming increasingly widespread,with confirmed surgical safety and tumor control effects,leading to growing support for minimally invasive treatment among hepatobiliary surgeons.Additionally,indocyanine green-guided fluorescence laparoscopic technology allows for precise lymph node dissection and liver resection,reducing the risk of postoperative complications.In light of the complex anatomy in the hepatic hilum and hepatoduodenal ligament region in IGC patients,performing delayed radical surgery using the 3D laparoscopic PH approach(based on the portal vein and hepatic artery as the anatomical axis)helps prevent organ damage and tumor dissemination.This review summarizes the current surgical treatment of IGC and discusses the application of the PH approach in laparoscopic gallbladder cancer radical surgery.关键词
意外胆囊癌/腹腔镜/门静脉/肝动脉Key words
Incidental Gallbladder Cancer/Laparoscopes/Portal Vein/Hepatic Artery分类
临床医学引用本文复制引用
罗琦漤,王敏,秦仁义..意外胆囊癌延迟根治术的进展与思考:3D腹腔镜PH路径的临床应用[J].中国普通外科杂志,2025,34(2):202-214,13.基金项目
国家自然科学基金资助项目(82273438). （82273438）
