Wysocki A
Kliniki Chirurgii Ogólnej II Katedry Chirurgii Ogólnej Collegium Medicum Uniwersytetu Jagiellońskiego.
Pol Merkur Lekarski. 2000 Oct;9(52):729-31.
In routine post operative microscopic test of unsuspected of cancer gallbladder--before or during laparoscopic cholecystectomy--cancer is recognized in 0.5% to 1%. Bad prognosis is mainly connected with how far advanced the cancer is. It seems that laparoscopic technic it is a disadvantage itself as it conduces to dissemination of cancer in peritoneal cavity and also in cicatrix. Our experience so far proofs that repeatedly during the second traditional operation--even up to several days after laparoscopy--dissemination of cancer is found in peritoneum. Today's views regarding treatment of not advanced cancer considerable are based on experience when the traditional operations were used to remove gallbladder. Further more--it permitted to accept that just cholecystectomy is sufficient in cases when cancer infiltration has not gone beyond mucous membrane. In cases of more advanced cancer extensive operations may prolong life. Due to that observation in cases of gallbladder with cancer infiltration beyond mucous membrane and removed in laparoscopic way an extensive operation is carried out later and it is taking in adherent liver parenchyma and lymphatic tissue in hepato-duodenal ligament or if necessary main biliary tract. Extensive operations are being carried out till microscopic routine test has been performed and few days after laparoscopic cholecystectomy. Some other solution rely during laparoscopic operation--on treating respective with thicken wall gallbladder as a suspected of cancer and microscopic test is carried out intraoperatively. It conditions accomplishment of extensive operation. It must be emphasise that laparoscopic technique encourages dissemination of cancer. From different point of view switching from laparoscopic to traditional cholecystectomy with 1% risk of cancer in thicken wall gallbladder against remaining will be deprived of benefits of laparoscopic operation. Still this quite complicated problem remains open to discussions, research and it needs some time yet before solution will be found.
在对未怀疑患有癌症的胆囊进行常规术后显微镜检查时（在腹腔镜胆囊切除术之前或期间），发现癌症的比例为0.5%至1%。预后不良主要与癌症的进展程度有关。似乎腹腔镜技术本身就是一个不利因素，因为它会导致癌症在腹腔和瘢痕中扩散。我们目前的经验证明，在第二次传统手术期间（甚至在腹腔镜检查后数天），多次在腹膜中发现癌症扩散。目前对于非晚期癌症治疗的观点很大程度上基于使用传统手术切除胆囊时的经验。此外，当癌症浸润未超出黏膜时，仅行胆囊切除术就被认为足够了。对于更晚期的癌症，广泛的手术可能会延长生命。基于这一观察结果，对于腹腔镜切除的、癌症浸润超出黏膜的胆囊，随后要进行广泛的手术，包括切除粘连的肝实质以及肝十二指肠韧带中的淋巴组织，必要时还包括主要胆道。广泛的手术一直进行到显微镜常规检查完成，且在腹腔镜胆囊切除术后数天。其他一些解决方案是在腹腔镜手术期间，将壁厚增厚的胆囊视为疑似癌症进行相应处理，并在术中进行显微镜检查。这决定了是否要进行广泛的手术。必须强调的是，腹腔镜技术会促使癌症扩散。从不同角度来看，对于壁厚增厚的胆囊，有1%的癌症风险，从腹腔镜手术转为传统胆囊切除术，相对于其他情况，将无法获得腹腔镜手术的益处。然而，这个相当复杂的问题仍有待讨论、研究，并且还需要一些时间才能找到解决方案。
