Frauenschuh D, Greim R, Kraas E
Chirurgische Abteilung, Zentrum für Minimal-Invasive Chirurgie, Krankenhaus Moabit, Berlin, Germany.
Langenbecks Arch Surg. 2000 Dec;385(8):495-500. doi: 10.1007/s004230000177.
Carcinoma of the gallbladder is a rare disease. Gallbladder carcinoma is detected in less than 1% of all gallstone operations. With the introduction of laparoscopic surgery and the higher acceptance of this technique, gallbladders are now removed much earlier than they used to be. With the increase of cholecystectomies, the diagnosis of unexpected gallbladder carcinoma became more frequent. We report on how to proceed in patients with a diagnosis of gallbladder carcinoma and discuss the additional problems that have arisen since laparoscopic cholecystectomy became established. From June 1990 to December 1999, we performed 6230 cholecystectomies in the surgical department of Moabit Hospital in Berlin. Of these, 42 (0.6%) were identified as carcinoma. There were 37 women and five men, and the mean age was 69 years. In 16 patients (39%), there was a preoperative suspicion of malignancy. In 26 patients (61%), malignancy was suspected intraoperatively or diagnosed postoperatively after pathologic examination of the resected gallbladder. In these patients, an open repeat operation was necessary in seven cases to achieve an adequate curative resection and staging. This involved additional liver bed resection and lymph node dissection of the hepatoduodenal ligament. Abdominal wall (port site) recurrence in the absence of distant metastasis was present only in two patients. We recommend removal using a bag in all gallbladders with wall thickening, irregularities, or scleroatrophic calcified gallbladder area. In stage Tis or T1, laparoscopic cholecystectomy is sufficient. In stage T2 and T3, we perform a repeat operation with liver bed resection and lymphadenectomy.
胆囊癌是一种罕见疾病。在所有胆囊结石手术中，胆囊癌的检出率不到1%。随着腹腔镜手术的引入以及该技术更高的接受度，现在胆囊切除的时机比过去要早得多。随着胆囊切除术数量的增加，意外胆囊癌的诊断变得更加频繁。我们报告了胆囊癌诊断患者的处理方法，并讨论了自腹腔镜胆囊切除术确立以来出现的其他问题。1990年6月至1999年12月，我们在柏林莫阿比特医院外科进行了6230例胆囊切除术。其中，42例（0.6%）被确诊为癌症。有37名女性和5名男性，平均年龄为69岁。16例患者（39%）术前怀疑有恶性肿瘤。26例患者（61%）术中怀疑有恶性肿瘤或在切除胆囊的病理检查后术后确诊。在这些患者中，7例需要进行开放性再次手术以实现充分的根治性切除和分期。这包括额外的肝床切除和肝十二指肠韧带淋巴结清扫。仅2例患者在无远处转移的情况下出现腹壁（穿刺部位）复发。对于所有有胆囊壁增厚、不规则或硬化萎缩钙化胆囊区域的胆囊，我们建议使用袋子取出。Tis期或T1期，腹腔镜胆囊切除术就足够了。T2期和T3期，我们进行肝床切除和淋巴结清扫的再次手术。
