Akyürek Nusret, Irkörücü Oktay, Salman Bülent, Erdem Ozlem, Sare Mustafa, Tatlicioğlu Ertan
Department of General Surgery, Hepato Pancreato Biliary Surgery Unit, Gazi University Medical School, Ankara, Turkey.
J Hepatobiliary Pancreat Surg. 2004;11(5):357-61. doi: 10.1007/s00534-004-0910-y.
BACKGROUND/PURPOSE: In the present study, we investigated the effectiveness of surgeons in determining incidental gallbladder pathologies at laparoscopic cholecystectomy (LC).
This study included 548 patients with gallstones who underwent LC between May 1, 2001 and October 15, 2003. The surgeon made an incision on the gallbladder wall for inspection, and palpated the mucosa after removing the gallbladder from the abdominal cavity to look for unsuspected pathologies. If an abnormal mucosa was observed or palpated, it was marked with a silk suture and then histopathologic examination was performed.
Fifty of 548 LC specimens were found to be suspi-cious by the surgeon. Histopathological examination of frozen sections revealed incidental pathologies in 15 of these specimens. Strikingly, 5 of these specimens were considered to have gallbladder cancer (GBC). The other incidental pathologies were consistent with adenomyomatosis, xanthogranulomatous cholecystitis, and fibroepithelial and hyperplastic polyps. Four of the other 498 specimens revealed incidental pathologies at definitive histopathological examination, and all of them were consistent with gastric metaplasia. The sensitivity and specificity of the procedure was 78.9% and 93%, respectively.
A simple prosedure; that is, incision and inspection, and palpation of the gallbladder, seems to be useful for the diagnosis of incidental gallbladder pathologies.
背景/目的：在本研究中，我们调查了外科医生在腹腔镜胆囊切除术（LC）中确定意外胆囊病变的有效性。
本研究纳入了2001年5月1日至2003年10月15日期间接受LC的548例胆结石患者。外科医生在胆囊壁上做切口进行检查，并在将胆囊从腹腔取出后触诊黏膜以寻找未被怀疑的病变。如果观察到或触诊到异常黏膜，用丝线缝合标记，然后进行组织病理学检查。
548例LC标本中有50例被外科医生怀疑有病变。冰冻切片的组织病理学检查显示其中15例标本有意外病变。令人惊讶的是，这些标本中有5例被认为患有胆囊癌（GBC）。其他意外病变与腺肌病、黄色肉芽肿性胆囊炎、纤维上皮息肉和增生性息肉一致。其他498例标本中有4例在最终组织病理学检查中发现意外病变，且均与胃化生一致。该操作的敏感性和特异性分别为78.9%和93%。
一种简单的操作，即切开、检查和触诊胆囊，似乎对诊断意外胆囊病变有用。
