Cho Jai Young, Han Ho-Seong, Yoon Yoo-Seok, Ahn Keun Soo, Kim Young-Hoon, Lee Kyoung-Ho
Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, Korea.
Arch Surg. 2010 Feb;145(2):128-33. doi: 10.1001/archsurg.2009.261.
To determine the feasibility of the laparoscopic approach for treating suspected early-stage gallbladder carcinoma.
DESIGN, SETTING, AND PATIENTS: Prospective study from a university hospital. From May 10, 2004, to October 9, 2007, the laparoscopic approach was considered for treating 36 patients with suspected gallbladder carcinoma at T2 or less without liver invasion based on the preoperative computed tomographic scan. To further exclude liver invasion, preoperative endoscopic ultrasonography (US) and laparoscopic US were additionally performed. Frozen biopsy was performed after completing the cholecystectomy. If carcinoma was found, laparoscopic lymphadenectomy was performed.
Feasibility and operative outcome.
Three patients who had liver invasion on endoscopic US underwent open surgery. An additional 3 patients who had liver invasion noted on laparoscopic US had their surgical procedure converted to laparotomy. Finally, 30 patients underwent a laparoscopic procedure. With combined computed tomography, endoscopic US, and laparoscopic US, the negative predictive value for excluding hepatic invasion reached 100%. For the 12 patients who had benign lesions noted on their frozen biopsies, their laparoscopic surgical procedure was completed. The remaining 18 patients who had gallbladder carcinoma underwent additional laparoscopic lymphadenectomy. During laparoscopic lymphadenectomy 1 conversion occurred owing to bleeding, the median operative time was 190 minutes, and the median blood loss was 50 mL. The complication rate was 16.7% and the median postoperative hospital stay was 4 days. After a median follow-up of 27 months, all 18 patients who underwent laparoscopic lymphadenectomy survived without any evidence of recurrence or metastasis.
Laparoscopic treatment is feasible and safe in selected patients with early-stage gallbladder carcinoma.
确定腹腔镜手术治疗疑似早期胆囊癌的可行性。
设计、地点和患者：来自一所大学医院的前瞻性研究。2004年5月10日至2007年10月9日，基于术前计算机断层扫描，对36例疑似T2期及以下且无肝脏侵犯的胆囊癌患者考虑采用腹腔镜手术治疗。为进一步排除肝脏侵犯，额外进行了术前内镜超声检查（US）和腹腔镜超声检查。胆囊切除术后进行冰冻活检。如果发现癌症，则进行腹腔镜淋巴结清扫术。
可行性和手术结果。
3例经内镜超声检查发现有肝脏侵犯的患者接受了开放手术。另外3例经腹腔镜超声检查发现有肝脏侵犯的患者将手术方式改为开腹手术。最后，30例患者接受了腹腔镜手术。结合计算机断层扫描、内镜超声和腹腔镜超声检查，排除肝脏侵犯的阴性预测值达到100%。对于12例冰冻活检显示为良性病变的患者，完成了腹腔镜手术。其余18例患有胆囊癌的患者接受了额外的腹腔镜淋巴结清扫术。在腹腔镜淋巴结清扫术中，1例因出血而改为开腹手术，中位手术时间为190分钟，中位失血量为50毫升。并发症发生率为16.7%，中位术后住院时间为4天。中位随访27个月后，所有18例行腹腔镜淋巴结清扫术的患者均存活，无复发或转移迹象。
对于部分早期胆囊癌患者，腹腔镜治疗是可行且安全的。
