Yokomuro Shigeki, Arima Yasuo, Mizuguchi Yoshiaki, Shimizu Tetsuya, Kawahigashi Yutaka, Kannda Tomohiro, Arai Masao, Tajiri Takashi
Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
J Nippon Med Sch. 2007 Aug;74(4):300-5. doi: 10.1272/jnms.74.300.
Eighty-four patients underwent laparoscopic cholecystectomy (LC) from January through August 2006. Of these patients, 4 (4.7%) were found to have occult gallbladder carcinoma (GC) either during or after the procedure. Two of the patients were women and 2 were men. The mean age was 75.0 years. One patient had mucosal tumors, 2 had subserosal tumors, and 1 had a serosal lesion. One of the 2 patients with subserosal tumors underwent radical surgery. In a previous study, 0.83% (10 of 1,195) of patients who had undergone LC were found to have occult GC, either during of after the procedure. The prevalence of gallbladder carcinoma has recently been increasing. GC has been reported in 0.3% to 1.5% of patients who have undergone cholecystectomy. Since the introduction of laparoscopic surgery, the number of cholecystectomies being performed has increased, which may explain why occult GC seems to be occurring more frequently. The prognosis for GC is poor, and surgical resection is the only potentially curative treatment. However, GC is difficult to diagnose at an early stage and difficult to recognize even in the advanced stages. Fifteen percent to 30% of patients show no preoperative or intraoperative evidence of malignancy. Occult GC is also increasing. Because flat infiltrating GC and GC with cholecystitis and numerous stones are difficult to diagnose preoperatively, we recommend taking frozen sections from patients who are of advanced age (older than 70 years), have a long history of stones, or have a thickened gallbladder wall.
2006年1月至8月期间，84例患者接受了腹腔镜胆囊切除术（LC）。在这些患者中，有4例（4.7%）在手术过程中或术后被发现患有隐匿性胆囊癌（GC）。其中2例患者为女性，2例为男性。平均年龄为75.0岁。1例患者为黏膜肿瘤，2例为浆膜下肿瘤，1例为浆膜病变。2例浆膜下肿瘤患者中有1例行根治性手术。在先前的一项研究中，接受LC的患者中有0.83%（1195例中的10例）在手术过程中或术后被发现患有隐匿性GC。胆囊癌的患病率最近一直在上升。据报道，接受胆囊切除术的患者中胆囊癌的患病率为0.3%至1.5%。自从引入腹腔镜手术以来，进行胆囊切除术的数量有所增加，这可能解释了为什么隐匿性GC似乎更频繁地出现。GC的预后很差，手术切除是唯一可能治愈的治疗方法。然而，GC在早期很难诊断，即使在晚期也很难识别。15%至30%的患者术前或术中没有恶性肿瘤的证据。隐匿性GC也在增加。由于扁平浸润性GC以及伴有胆囊炎和大量结石的GC术前难以诊断，我们建议对年龄较大（70岁以上）、有长期结石病史或胆囊壁增厚的患者进行冰冻切片检查。
