Winston C B, Chen J W, Fong Y, Schwartz L H, Panicek D M
Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Radiology. 1999 Aug;212(2):439-44. doi: 10.1148/radiology.212.2.r99au17439.
To describe the computed tomographic (CT) appearance of recurrent gallbladder carcinoma along port tracks after laparoscopic cholecystectomy and to assess the effect of recurrence on patient care.
Seventeen abdominal CT scans in 16 of 19 consecutive patients who underwent hepatic resection for gallbladder carcinoma diagnosed at laparoscopic cholecystectomy were reviewed retrospectively. Medical records were reviewed to determine the clinical effect of tumor recurrence along a port track.
CT revealed 12 tumor recurrences along laparoscopic port tracks in six (32%) patients (mean, two recurrences per patient; range, one to four per patient). Eight (67%) CT-depicted recurrences appeared homogeneous, and nine (75%) directly involved subjacent omental fat. The mass was the only site of recurrence at CT in two (33%) patients. The presence of an abdominal wall tumor recurrence affected patient care in four (67%) of six patients. Histopathologic examination results confirmed recurrent tumor in all five (100%) patients who underwent biopsy.
Tumor recurrence along port tracks is a potential complication of laparoscopic cholecystectomy when gallbladder carcinoma is present, even after subsequent hepatic resection is performed for attempted cure. Recurrences appear as a new or enlarging abdominal wall mass, often involving subjacent omental fat, and may be the only site of recurrent disease at CT. Demonstration of abdominal wall tumor recurrence affects patient care.
描述腹腔镜胆囊切除术后胆囊癌沿穿刺孔道复发的计算机断层扫描(CT)表现,并评估复发对患者治疗的影响。
回顾性分析19例连续接受胆囊癌肝切除术患者中的16例患者的17份腹部CT扫描,这些患者在腹腔镜胆囊切除术中被诊断为胆囊癌。查阅病历以确定沿穿刺孔道肿瘤复发的临床影响。
CT显示6例(32%)患者的腹腔镜穿刺孔道有12处肿瘤复发(平均每位患者2处复发;范围为每位患者1至4处)。8处(67%)CT显示的复发表现为均匀性,9处(75%)直接累及下方网膜脂肪。在2例(33%)患者中,肿块是CT上唯一的复发部位。6例患者中有4例(67%)腹壁肿瘤复发影响了患者的治疗。在所有5例(100%)接受活检的患者中,组织病理学检查结果证实为复发性肿瘤。
当存在胆囊癌时,即使在随后进行了旨在治愈的肝切除术后,沿穿刺孔道的肿瘤复发仍是腹腔镜胆囊切除术的一种潜在并发症。复发表现为新出现或增大的腹壁肿块,常累及下方网膜脂肪,且可能是CT上复发性疾病的唯一部位。腹壁肿瘤复发的显示会影响患者的治疗。