Morine Yuji, Shimada Mitsuo, Imura Satoru, Fujii Masahiko, Ikemoto Tetsuya, Soejima Yuji, Utsunomiya Toru, Kurita Nobuhiro, Miyake Hidenori, Tashiro Seiki
Department of Surgery, The University of Tokushima, Japan.
Hepatogastroenterology. 2008 Nov-Dec;55(88):1965-70.
BACKGROUND/AIMS: The postoperative survival rate is dependent on the invasive depth of the gallbladder carcinoma. When this carcinoma has invaded beyond the subserosal layer, lymph node and adjacent organ involvement is found in a large number of patients, and long-term survival cannot be achieved. The aim of this study is to establish a surgical strategy for advanced gallbladder carcinoma according to the invasive depth.
A retrospective analysis was conducted of 44 patients with the gallblader carcinoma. The invasive depth was histologically defined by the Japanese Society of Biliary Surgery system as follows. (hinf0: within muscle layer, hinf1a: subserosal layer, hinf1b: hepatic infiltration within 5 mm, hinf2.3: hepatic infiltration more than 5 mm)
Wedge resection of the gallbladder bed was performed in 5 cases, and in four of the five patients (80%), intrahepatic recurrence occurred within 6 months. S4a+S5 subsegmentectomy of the liver is performed in 11 cases (hinf0,1a/b:n=5, hinf2,3:n=6) and the postoperative survival rate was significantly better in cases of hinf0,1a/b (p<0.05). In cases of hinf2,3 an extended hepatic lobectomy (n=5) tended to obtain a better survival rate, compared with S4a+S5 subsegmentectomy (n=6)(p=0.13).
S4a+S5 subsegmentectomy of the liver is a standard operation for GB carcinoma with subserosal invasion.
背景/目的：胆囊癌术后生存率取决于肿瘤浸润深度。当胆囊癌浸润超过浆膜下层时，大量患者会出现淋巴结及邻近器官受累，难以实现长期生存。本研究旨在根据浸润深度制定晚期胆囊癌的手术策略。
对44例胆囊癌患者进行回顾性分析。肿瘤浸润深度按照日本胆道外科学会系统进行组织学定义，如下所示。（hinf0：肌层内；hinf1a：浆膜下层；hinf1b：肝浸润深度≤5mm；hinf2,3：肝浸润深度＞5mm）
5例行胆囊床楔形切除术，其中4例（80%）在6个月内出现肝内复发。11例行肝S4a+S5亚段切除术（hinf0、1a/b：n=5；hinf2、3：n=6），hinf0、1a/b组术后生存率显著更高（p<0.05）。hinf2、3组中，与S4a+S5亚段切除术（n=6）相比，扩大肝叶切除术（n=5）的生存率有提高趋势（p=0.13）。
肝S4a+S5亚段切除术是浆膜下浸润性胆囊癌的标准术式。
