Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, C-308, Philadelphia, PA 19111, USA.
Surg Endosc. 2010 Jul;24(7):1766-8. doi: 10.1007/s00464-009-0840-5. Epub 2010 Jan 7.
Although laparoscopic cholecystectomy was one of the first laparoscopic procedures, gallbladder cancer has been one of the last malignancies tackled with minimally invasive techniques. This video reviews the minimally invasive approaches to preoperatively suspected gallbladder cancer.
Like the standard laparoscopic cholecystectomy, the minimally invasive procedure is performed with four trocars. The surgeon operates with the patient in the French position. A totally laparoscopic radical cholecystectomy including wedge resections of segments IVB and V is undertaken with hepatoduodenal lymphadenectomy and common bile duct excision. The biliary system is reconstructed via a laparoscopic choledochojejunostomy.
Six patients have undergone laparoscopic radical cholecystectomy. Three of these patients were found to have gallbladder cancer according to the final pathology. All the final surgical margins were negative, and the average lymph node retrieval was 3 (range, 1-6).
The minimally invasive approach to gallbladder cancer is feasible and safe. It should currently be performed in high-volume centers with expertise in both hepatobiliary and minimally invasive surgery. Larger trials are needed to determine whether either the open or laparoscopic approach offers any advantage.
尽管腹腔镜胆囊切除术是最早的腹腔镜手术之一，但胆囊癌一直是最后采用微创技术治疗的恶性肿瘤之一。本视频回顾了术前疑似胆囊癌的微创治疗方法。
与标准的腹腔镜胆囊切除术一样，微创手术采用四个 Trocar 进行。外科医生让患者处于法国体位进行操作。通过肝十二指肠淋巴结清扫和胆总管切除，进行包括 IVB 和 V 段楔形切除的全腹腔镜根治性胆囊切除术。通过腹腔镜胆管空肠吻合术重建胆道系统。
六名患者接受了腹腔镜根治性胆囊切除术。根据最终病理检查，其中 3 名患者被诊断为胆囊癌。所有最终的手术切缘均为阴性，平均淋巴结检出数为 3 个（范围 1-6 个）。
微创治疗胆囊癌是可行且安全的。目前，它应该在具有肝胆和微创外科专业知识的高容量中心进行。需要更大规模的试验来确定开放或腹腔镜方法是否具有任何优势。
