Kubota K, Toyoda H, Noie T, Abe H, Watanabe M, Makuuchi M
Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan.
Hepatogastroenterology. 1999 Nov-Dec;46(30):3077-82.
BACKGROUND/AIMS: With an increase in laparoscopic cholecystectomy (LC) cases, unsuspected gallbladder cancers have been reported and intraabdominal cancer dissemination has been identified as a crucial problem. Since September 1991, we employed LC with full-thickness dissection (LC-F) for polypoid lesions of the gallbladder. In the present study, the utility of the procedure was investigated.
For 261 patients who underwent standard LC (S-LC) or LC-F between September 1991 and August 1996, the operation time, intra- and post-operative complications relevant to the operative technique, histological findings of the gallbladders, and prognosis of each patient with gallbladder cancer were evaluated.
S-LC and LC-F were performed in 231 and 30 patients, respectively. The mean operation times for S-LC and LC-F were 157 and 120 min, respectively, (p < 0.05). Gallbladder perforation occurred in 29 S-LCs, whereas there was none in 30 LC-Fs (p < 0.05). Bleeding from the gallbladder bed occurred in 1 patient in each of the 2 groups, but was stopped easily. There was neither post-operative bleeding nor bile leakage in either group. Mucosal cancer was diagnosed in 3 gallbladders resected by S-LC and 1 resected by LC-F. One patient of the LC-F group with advanced cancer underwent laparotomy. All the patients have no signs of recurrence.
LC-F allows the complete removal of the connective tissue of the gallbladder bed without perforation and, therefore, is considered as a safe and useful procedure for resecting gallbladders with potentially cancerous lesions.
背景/目的：随着腹腔镜胆囊切除术（LC）病例的增加，已报道了意外胆囊癌，且腹腔内癌症播散已被确认为一个关键问题。自1991年9月起，我们对胆囊息肉样病变采用全层剥离的腹腔镜胆囊切除术（LC-F）。在本研究中，对该手术方法的实用性进行了调查。
对于1991年9月至1996年8月期间接受标准LC（S-LC）或LC-F的261例患者，评估了手术时间、与手术技术相关的术中和术后并发症、胆囊的组织学发现以及每位胆囊癌患者的预后。
分别对231例和30例患者进行了S-LC和LC-F。S-LC和LC-F的平均手术时间分别为157分钟和120分钟（p<0.05）。29例S-LC发生胆囊穿孔，而30例LC-F均未发生（p<0.05）。两组各有1例患者发生胆囊床出血，但均易于止血。两组均未发生术后出血或胆漏。S-LC切除的3个胆囊和LC-F切除的1个胆囊诊断为黏膜癌。LC-F组1例晚期癌症患者接受了剖腹手术。所有患者均无复发迹象。
LC-F能够完整切除胆囊床的结缔组织而不发生穿孔，因此，被认为是切除有潜在癌性病变胆囊的一种安全且有用的手术方法。
