Goetze Thorsten Oliver, Paolucci Vittorio
Department of Surgery, Ketteler-Krankenhaus, 63071, Offenbach, Germany.
World J Surg. 2009 Oct;33(10):2161-5. doi: 10.1007/s00268-009-0163-7.
Accidental intraoperative gallbladder perforation is a problem in laparoscopic surgery, especially in cases with incidental gallbladder carcinoma (IGBC). The question is whether intraoperative gallbladder perforation has a prognostic disadvantage or a retrieval bag provides protection against tumor dissemination.
A standardized questionnaire was sent to all German surgical clinics based on the central register of "incidental gallbladder carcinoma" of the German Society of Surgery founded in 1997.
In 592 IGBC-registered cases, there were 330 laparoscopies, 154 open surgeries, and intraoperative conversion was performed in 106 cases. Of laparoscopic surgeries (n = 330), the recurrence rate was 30%. The recurrence rate for cases with (174/330) and without (156/330) the use of retrieval bag was 32.2% and 27%, respectively. In laparoscopies with intraoperative gallbladder perforation (73/330 cases), the recurrence rate was 38.4%. Of these cases the recurrence rate with (51/73) and without (22/73) the use of retrieval bags was 39.2% and 36.4%, respectively. In 257 cases without intraoperative perforation, tumor recurrence rate was 27.2%, and it was 29.3% or 25.4% with (123/257) and without (134/257) the use of retrieval bags.
According to the registry data, the intraoperative gallbladder perforation results in significant (P = 0.047) prognostic disadvantage and in these cases retrieval bags were used more often (P = 0.001). However, in IGBC cases if intraoperative gallbladder perforation has already happened, the use of retrieval bags had no protective effects.
术中意外胆囊穿孔是腹腔镜手术中的一个问题，尤其是在意外胆囊癌（IGBC）病例中。问题在于术中胆囊穿孔是否具有预后劣势，或者使用取物袋是否能防止肿瘤播散。
基于1997年成立的德国外科学会“意外胆囊癌”中央登记册，向所有德国外科诊所发送了一份标准化问卷。
在592例登记的IGBC病例中，有330例进行了腹腔镜手术，154例进行了开放手术，106例进行了术中中转。在腹腔镜手术（n = 330）中，复发率为30%。使用（174/330）和未使用（156/330）取物袋的病例复发率分别为32.2%和27%。在术中发生胆囊穿孔的腹腔镜手术（73/330例）中，复发率为38.4%。在这些病例中，使用（51/73）和未使用（22/73）取物袋的复发率分别为39.2%和36.4%。在257例未发生术中穿孔的病例中，肿瘤复发率为27.2%，使用（123/257）和未使用（134/257）取物袋的复发率分别为29.3%和25.4%。
根据登记数据，术中胆囊穿孔导致显著的（P = 0.047）预后劣势，并且在这些病例中更频繁地使用了取物袋（P = 0.001）。然而，在IGBC病例中，如果已经发生术中胆囊穿孔，使用取物袋没有保护作用。
