Molnár Béla Akos, Varga-Szabó Dávid, Kaliszky Péter
Semmelweis Egyetem, Altalános Orvostudományi Kar, I. Sebészeti Klinika, Budapest.
Orv Hetil. 2005 Dec 11;146(50):2541-5.
In Hungary surgeons perform approximately 24000 cholecystectomies per year. Nowadays the choice of treatment of uncomplicated cholelithiasis is laparoscopic cholecystectomy. The advantages and popularity of the procedure are well known; otherwise the exploration of the abdominal cavity is not so complete than during open surgery. In the course of laparoscopic surgery the surgeon has minimal chance to find the preoperatively not diagnosed tumour.
In our retrospective study we analysed those complains and clinical signs, when we suspect the presence of a pancreas tumour.
We analysed the clinical data of patients who were operated on with pancreatic tumor and before the surgery, laparoscopic cholecystectomy had been performed in the previous 24 month.
In the period of 1996-2003 we operated 1515 patients with pancreatic tumor, at our clinic. 21 patients (1.39%) had laparoscopic cholecystectomy in the last 24 month, before the surgery. The age of the patients was between 50-78 (average age 65), the rate of the female and male patients was 15/6. Most of the patients had weight loss (in 11 cases it was considerable, 5.4 kg in one month) and the uncertain abdominal pain, feeling of discomfort, meteorism was also characteristic of these patients. In 16 cases (76%) the blood glucose level had been elevated. The ultrasound examination before the cholecystectomy in these cases was focused to the gall bladder. After the cholecystectomy, complains did not disappear definitely and further diagnostic steps verified the pancreatic tumour. The average time between the laparoscopic cholecystectomy and the open surgery was 10 month. In 4 cases we were able to remove the tumor, but in 17 cases only palliative operation was performed.
If the patient is over the age of 50, especially if he is male, has weight loss and if the symptoms are not characteristic of gallbladder disease, further diagnostic steps are necessary before cholecystectomy. Complains remaining after laparoscopic cholecystectomy must be indication for urgent diagnostic steps. The life expectancy of patients with advanced pancreatic tumor is very poor.
在匈牙利，外科医生每年大约进行24000例胆囊切除术。如今，非复杂性胆结石的治疗选择是腹腔镜胆囊切除术。该手术的优点和普及程度众所周知；然而，与开腹手术相比，腹腔探查并不那么彻底。在腹腔镜手术过程中，外科医生发现术前未诊断出的肿瘤的机会微乎其微。
在我们的回顾性研究中，我们分析了怀疑存在胰腺肿瘤时的那些症状和临床体征。
我们分析了患有胰腺肿瘤且在手术前24个月内曾接受过腹腔镜胆囊切除术的患者的临床资料。
在1996年至2003年期间，我们诊所为1515例胰腺肿瘤患者实施了手术。21例患者（1.39%）在手术前的最后24个月内接受了腹腔镜胆囊切除术。患者年龄在50至78岁之间（平均年龄65岁），男女患者比例为15/6。大多数患者体重减轻（11例体重减轻明显，其中1例在一个月内减轻5.4千克），这些患者还具有不确定的腹痛、不适感、腹胀等特征。16例（76%）患者血糖水平升高。这些病例在胆囊切除术前的超声检查主要针对胆囊。胆囊切除术后，症状并未完全消失，进一步的诊断步骤证实了胰腺肿瘤。腹腔镜胆囊切除术与开腹手术之间的平均时间为10个月。4例患者成功切除了肿瘤，但17例仅进行了姑息性手术。
如果患者年龄超过50岁，尤其是男性，体重减轻且症状不符合胆囊疾病特征，则在胆囊切除术前需要进一步的诊断步骤。腹腔镜胆囊切除术后仍存在的症状必须成为紧急诊断步骤的指征。晚期胰腺肿瘤患者的预期寿命非常低。
