Gumbs Andrew A, Milone Luca, Geha Rula, Delacroix Johanna, Chabot John A
Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA.
J Laparoendosc Adv Surg Tech A. 2009 Aug;19(4):519-20. doi: 10.1089/lap.2008.0231.
Controversy exists as to the role of minimally invasive techniques in the management of early gallbladder cancer. The majority of early gallbladder cancers are diagnosed upon final pathology after laparoscopic cholecystectomy. For stage pT1a tumors, no further surgery is warranted; however, for pT1b or greater lesions, patients usually undergo port-site excisions and completion of open radical cholecystectomy involving a partial hepatectomy of segments IV and V and a lymphadenectomy of the hepatoduodenal ligament. Presented in this paper is a totally laparoscopic radical cholecystectomy performed for suspected early gallbladder cancer. Despite the fact that a preoperative serum IgG4 level was within normal limits, final pathology was consistent with autoimmune cholecystitis. As a result, the laparoscopic radical cholecystectomy may be useful in select patients with a preoperative suspicion of early-stage gallbladder cancer by sparing them the necessity of a second-stage open procedure.
关于微创技术在早期胆囊癌治疗中的作用存在争议。大多数早期胆囊癌是在腹腔镜胆囊切除术后的最终病理检查中被诊断出来的。对于pT1a期肿瘤，无需进一步手术；然而，对于pT1b期或更严重的病变，患者通常要进行端口部位切除，并完成开放性根治性胆囊切除术，包括IV段和V段的部分肝切除术以及肝十二指肠韧带淋巴结清扫术。本文介绍了一例因疑似早期胆囊癌而进行的完全腹腔镜根治性胆囊切除术。尽管术前血清IgG4水平在正常范围内，但最终病理结果符合自身免疫性胆囊炎。因此，腹腔镜根治性胆囊切除术对于术前怀疑为早期胆囊癌的特定患者可能有用，可避免他们进行二期开放手术。
