分期腹腔镜检查在原发性胆囊癌中的作用——409 例患者分析：一项前瞻性研究，旨在评估分期腹腔镜检查在胆囊癌治疗中的作用。

The role of staging laparoscopy in primary gall bladder cancer--an analysis of 409 patients: a prospective study to evaluate the role of staging laparoscopy in the management of gallbladder cancer.

机构信息

Department of Gastrointestinal Surgery and Liver Transplant, Govind Ballabh Pant Hospital and Maulana Azad Medical College, Delhi University, New Delhi, India.

出版信息

Ann Surg. 2013 Aug;258(2):318-23. doi: 10.1097/SLA.0b013e318271497e.

DOI:10.1097/SLA.0b013e318271497e

PMID:23059504

Abstract

OBJECTIVE

To evaluate the role of staging laparoscopy (SL) in the management of gallbladder cancer (GBC).

METHODS

A prospective study of primary GBC patients between May 2006 and December 2011. The SL was performed using an umbilical port with a 30-degree telescope. Early GBC included clinical stage T1/T2. A detectable lesion (DL) was defined as one that could be detected on SL alone, without doing any dissection or using laparoscopic ultrasound (surface liver metastasis and peritoneal deposits). Other metastatic and locally advanced unresectable disease qualified as undetectable lesions (UDL).

RESULTS

Of the 409 primary GBC patients who underwent SL, 95 had disseminated disease [(surface liver metastasis (n = 29) and peritoneal deposits (n = 66)]. The overall yield of SL was 23.2% (95/409). Of the 314 patients who underwent laparotomy, an additional 75 had unresectable disease due to surface liver metastasis (n = 5), deep parenchymal liver metastasis (n = 4), peritoneal deposits (n = 1), nonlocoregional lymph nodes (n = 47), and locally advanced unresectable disease (n = 18), that is, 6-DL and 69-UDL. The accuracy of SL for detecting unresectable disease and DL was 55.9% (95/170) and 94.1% (95/101), respectively. Compared with early GBC, the yield was significantly higher in locally advanced tumors (n = 353) [25.2% (89/353) vs 10.7% (6/56), P = 0.02]. However, the accuracy in detecting unresectable disease and a DL in locally advanced tumors was similar to early GBC [56.0%, (89/159) and 94.1%, (89/95) vs 54.6% (6/11) and 100% (6/6), P = 1.00].

CONCLUSIONS

In the present series with an overall resectability rate of 58.4%, SL identified 94.1% of the DLs and thereby obviated a nontherapeutic laparotomy in 55.9% of patients with unresectable disease and 23.2% of overall GBC patients. It had a higher yield in locally advanced tumors than in early-stage tumors; however, the accuracy in detecting unresectable disease and a DL were similar.

摘要

目的

评估腹腔镜分期术（SL）在胆囊癌（GBC）治疗中的作用。

方法

对 2006 年 5 月至 2011 年 12 月期间的原发性 GBC 患者进行前瞻性研究。使用带有 30 度望远镜的脐部端口进行 SL。早期 GBC 包括临床分期 T1/T2。可检测病变（DL）定义为仅通过 SL 即可检测到的病变，无需进行任何解剖或使用腹腔镜超声（表面肝转移和腹膜沉积物）。其他转移性和局部晚期不可切除疾病被归类为不可检测病变（UDL）。

结果

在 409 例接受 SL 的原发性 GBC 患者中，95 例有播散性疾病[（表面肝转移（n=29）和腹膜沉积物（n=66）]。SL 的总体检出率为 23.2%（95/409）。在接受剖腹手术的 314 例患者中，由于表面肝转移（n=5）、深部实质肝转移（n=4）、腹膜沉积物（n=1）、非局部区域淋巴结（n=47）和局部晚期不可切除疾病（n=18），又有 75 例患者不可切除，即 6-DL 和 69-UDL。SL 检测不可切除疾病和 DL 的准确性分别为 55.9%（95/170）和 94.1%（95/101）。与早期 GBC 相比，局部晚期肿瘤的检出率明显更高（n=353）[25.2%（89/353）比 10.7%（6/56），P=0.02]。然而，在局部晚期肿瘤中，SL 检测不可切除疾病和 DL 的准确性与早期 GBC 相似[56.0%（89/159）和 94.1%（89/95）比 54.6%（6/11）和 100%（6/6），P=1.00]。