Department of Surgery, Clinica Alemana Santiago, Vitacura, Santiago, Chile.
Surg Endosc. 2010 Sep;24(9):2192-6. doi: 10.1007/s00464-010-0925-1. Epub 2010 Feb 23.
The aim of this study was to evaluate the role that laparoscopy plays in the management of gallbladder cancer.
From August 2005 to March 2009, 23 patients affected by gallbladder cancer detected after the study of a cholecystectomy specimen underwent laparoscopy as part of their management.
Among the patients, 5 underwent only an exploratory laparoscopy, while 11 were converted due to the existence of dense adhesions that precluded a complete exploration. Of the patients with adhesions who underwent conversion, three were unresectable. The remainder underwent a lymphadenectomy and liver resection after conversion. Of the seven who underwent a complete laparoscopic exploration, five had a lymphadenectomy and liver resection done completely by laparoscopy while conversion was needed for two. Conversion was required due to lymphatic metastasis at the hepatic pedicle and the presence of a bile leak. Postoperative time was uneventful, with patients discharged within 3 days of the operation.
Laparoscopy may be employed in the management of patients with early forms of gallbladder cancer undergoing reoperation. Although the presence of adhesions may result in inadequate exploration, there is a subset of patients for whom it is possible to perform a complete exam. Furthermore, laparoscopic lymphadenectomy and gallbladder bed resection is a promising technique in well-selected patients.
本研究旨在评估腹腔镜在胆囊癌治疗中的作用。
2005 年 8 月至 2009 年 3 月，23 例胆囊切除术后标本检查发现胆囊癌患者接受了腹腔镜检查。
其中 5 例仅行探查性腹腔镜检查，11 例因粘连严重而无法完全探查而中转开腹。粘连中转开腹的 3 例无法切除。其余患者在中转开腹后行淋巴结清扫和肝切除术。7 例完全行腹腔镜探查的患者中，5 例行腹腔镜下淋巴结清扫和肝切除术，2 例因肝门部淋巴结转移和胆漏而中转开腹。术后时间无并发症，患者均在术后 3 天内出院。
腹腔镜检查可用于治疗行再次手术的早期胆囊癌患者。尽管粘连的存在可能导致探查不充分，但对于某些患者来说，仍有可能进行全面检查。此外，腹腔镜下淋巴结清扫和胆囊床切除术在选择合适的患者中是一种有前途的技术。
