Lacaine F
Service de Chirurgie Digestive et Viscérale, Hôpital Tenon, Paris.
J Chir (Paris). 2003 Apr;140(2):115-9.
Contrary to the fears raised in surgical publications of the 1950's and 60's, the prognosis of porcelain gallbladder is not automatically associated with an increased risk of gallbladder carcinoma. Two recent cohort studies have allowed a better definition of the appropriate therapeutic attitude for a patient with a calcified gallbladder. In cases of "true" porcelain gallbladder, i.e., the presence of complete transmural calcification of the entire gallbladder wall, indications for cholecystectomy are based on biliary symptoms, all the more so since choledocholithiasis is often associated with porcelain gallbladder. In the case of partial calcification of the gallbladder, i.e., focal plaques of calcification involving the mucosa, prophylatic operative treatment is indicated. In these cases, the incidence of malignancy is markedly increased (14 times that of a control population). Cholecystectomy can still be performed laparascopically as long as the rules for prevention of peritoneal dissemination of tumor cells are scrupulously observed--the gallbladder should not be opened nor bile spilled, the specimen should be placed in a bag for removal through the abdominal wall, the pneumoperitoneum should be evacuated with the trocars still in place and the specimen should be opened and examined after removal with immediate frozen section pathologic exam if there is any question of tumor.
与20世纪50年代和60年代外科出版物中所提出的担忧相反，瓷胆囊的预后并非必然与胆囊癌风险增加相关。最近的两项队列研究使得对于钙化胆囊患者的适当治疗态度有了更好的界定。在“真性”瓷胆囊的情况下，即整个胆囊壁存在完全透壁钙化，胆囊切除术的指征基于胆道症状，鉴于胆总管结石常与瓷胆囊相关，这一点就更为重要。在胆囊部分钙化的情况下，即涉及黏膜的局灶性钙化斑块，建议进行预防性手术治疗。在这些病例中，恶性肿瘤的发生率显著增加（是对照人群的14倍）。只要严格遵守预防肿瘤细胞腹膜播散的规则，胆囊切除术仍可通过腹腔镜进行——不应打开胆囊，不应溢出胆汁，标本应置于袋中通过腹壁取出，气腹应在套管仍在位时排出，并且如果有肿瘤问题，标本应在取出后打开并检查，同时立即进行冷冻切片病理检查。
