Tuveri Massimiliano, Tuveri Augusto
Dipartimento di Chirurgia Generale e Vascolare, Clinica Sant'Elena, Quartu Sant'Elena, Cagliari, Italia.
Surg Laparosc Endosc Percutan Tech. 2007 Apr;17(2):141-4. doi: 10.1097/SLE.0b013e31803c766a.
Metastatic involvement of the gallbladder in melanoma is rare, but constitutes the most common metastatic lesion involving this organ. The surgical management seems to be indicated for patients with isolated and resectable gallbladder metastases to avoid symptoms or tumor complications. We report on a case of a young woman with an isolated metastatic gallbladder melanoma who presented with symptoms of acute cholecystitis. The patient underwent laparoscopic cholecystectomy (LC) and lymphadenectomy of the hepatoduodenal ligament. Histology was characteristic for metastatic malignant melanoma. Nodes were negative for metastases. We emphasize the appropriateness of a laparoscopic approach, once ruled out a widespread metastatic disease. It can be done with a remarkably low rate of complications. Gentle manipulation, avoidance of perforation, and use of a retrieval bag for the removal of the gallbladder should be practiced to help minimize the chance of mechanical exfoliation or implantation of malignant cells during LC. In isolated metastatic localization, LC may be curative and provide adequate palliation of symptoms with a short convalescence and a fast recovery.
黑色素瘤转移累及胆囊罕见，但却是累及该器官最常见的转移病变。对于孤立且可切除的胆囊转移患者，手术治疗似乎是必要的，以避免出现症状或肿瘤并发症。我们报告一例年轻女性孤立性转移性胆囊黑色素瘤病例，该患者表现为急性胆囊炎症状。患者接受了腹腔镜胆囊切除术（LC）及肝十二指肠韧带淋巴结清扫术。组织学检查显示为转移性恶性黑色素瘤特征。淋巴结未见转移。我们强调，一旦排除广泛转移性疾病，腹腔镜手术方法是合适的。该手术并发症发生率极低。术中应轻柔操作，避免穿孔，并使用取物袋取出胆囊，以尽量减少LC期间恶性细胞机械脱落或种植的机会。在孤立性转移定位中，LC可能具有治愈性，并能使症状得到充分缓解，恢复期短且恢复快。
