Shimizu Tetsuya, Arima Yasuo, Yokomuro Shigeki, Yoshida Hiroshi, Mamada Yasuhiro, Nomura Tsutomu, Taniai Nobuhiko, Aimoto Takayuki, Nakamura Yoshiharu, Mizuguchi Yoshiaki, Kawahigashi Yutaka, Uchida Eiji, Akimaru Koho, Tajiri Takashi
Surgery for Organ Function and Biology Regulation, Nippon Medical School Graduate School of Medicine, Tokyo, Japan.
J Nippon Med Sch. 2006 Jun;73(3):136-40. doi: 10.1272/jnms.73.136.
With the increasingly widespread acceptance of laparoscopic cholecystectomy (LC), the number of cases of incidental gallbladder carcinoma (GBC) has increased; however, management of incidental GBC is a difficult issue in the absence of established guidelines. The present study aims to evaluate the treatment of patients with incidental GBC diagnosed with LC. We performed a 14-year review of 10 patients with GBC discovered with LC. From April 1991 through March 2004, we performed LC for 1,195 patients at Nippon Medical School Main Hospital. Of these patients, 10 (0.83%) were found to have GBC. Seven patients were women and 3 were men, with a mean age of 61.4 years. Four patients had mucosal tumors (pT1a), 5 had subserosal tumors (pT2), and 1 had a serosal lesion (pT3). Eight of the 10 patients underwent radical surgery. Two patients with pT1a tumors underwent no additional surgery. All 4 patients with pT1a tumors are alive without recurrence. One patient with a pT2 tumor with metastases to the liver and pericholedochal lymph nodes found with additional resection died of recurrence of metastasis to the liver and lung 70 months after LC. One patient with a pT2 tumor died of primary lung cancer 35 months after LC. The remaining 3 patients with pT2 tumors are alive without recurrence 51 to 128 months after surgery. One patient with a pT3 tumor is alive with no recurrence for 9 months. For stage Tis or T1a tumors, LC is sufficient. Patients with T1b tumors should undergo liver-bed resection and lymphadenectomy, and patients with >pT2 tumors should undergo systematic liver resection with lymphadenectomy. Even when incidental GBC diagnosed with LC is advanced, adequate additional surgery may improve the prognosis.
随着腹腔镜胆囊切除术（LC）越来越广泛地被接受，意外胆囊癌（GBC）的病例数有所增加；然而，在缺乏既定指南的情况下，意外GBC的管理是一个难题。本研究旨在评估经LC诊断的意外GBC患者的治疗情况。我们对10例经LC发现GBC的患者进行了为期14年的回顾性研究。从1991年4月至2004年3月，我们在日本医科大学附属医院为1195例患者实施了LC。在这些患者中，10例（0.83%）被发现患有GBC。7例为女性，3例为男性，平均年龄61.4岁。4例患者为黏膜肿瘤（pT1a），5例为浆膜下肿瘤（pT2），1例为浆膜病变（pT3）。10例患者中有8例接受了根治性手术。2例pT1a肿瘤患者未接受额外手术。所有4例pT1a肿瘤患者均存活且无复发。1例pT2肿瘤患者在额外切除术中发现肝和肝门周围淋巴结转移，在LC后70个月死于肝和肺转移复发。1例pT2肿瘤患者在LC后35个月死于原发性肺癌。其余3例pT2肿瘤患者在手术后51至128个月存活且无复发。1例pT3肿瘤患者存活9个月无复发。对于Tis或T1a期肿瘤，LC就足够了。T1b期肿瘤患者应行肝床切除和淋巴结清扫，pT2期以上肿瘤患者应行系统性肝切除和淋巴结清扫。即使经LC诊断的意外GBC已进展，适当的额外手术仍可能改善预后。
