Yamaguchi K, Chijiiwa K, Ichimiya H, Sada M, Kawakami K, Nishikata F, Konomi K, Tanaka M
Department of Surgery I, Kyushu University Faculty of Medicine, Fukuoka, Japan.
Arch Surg. 1996 Sep;131(9):981-4; discussion 985. doi: 10.1001/archsurg.1996.01430210079015.
To assess the usefulness of laparoscopic cholecystectomy for unsuspected and suspected gallbladder carcinoma.
Retrospective review with a mean follow-up of 27 months, ranging from 1 to 47 months.
University hospital and 8 affiliated hospitals.
Of 2616 laparoscopic cholecystectomies performed over 4 years, 24 gallbladder carcinomas were treated by laparoscopic cholecystectomy and retrospectively reviewed.
The clinical course depended on the histopathologic depth of invasion of gallbladder carcinoma. All 6 cases of pathologic tumor (pT) stage in situ (pTis) gallbladder carcinoma and 2 cases of pT1 gallbladder carcinoma showed no invasion to the lymphatic, venous, or perineural spaces, and these 8 patients were all doing well from 2 to 19 months (mean, 11 months) after laparoscopic cholecystectomy. Sixteen cases of pT2 or pT3 gallbladder carcinoma invaded the subserosal layer or the liver, and 5 of the 16 patients were dead of liver dysfunction, abdominal wound recurrence, or liver metastasis 5 days and 7, 12, 15, and 18 months after operation, although additional resection of the liver bed with lymph node dissection was performed after laparoscopic cholecystectomy in 4 of these 5 patients. Abdominal wall recurrence in the absence of distant metastasis was present in 3 (19%) of the 16 patients with pT2 or pT3 gallbladder carcinoma due to inoculation of cancer cells in the abdominal stab wounds where the gallbladder or laparoscope was removed.
Gallbladder carcinoma at the pTis or pT1 stage removed laparoscopically needs no other treatment. We recommend that the gallbladder be removed by vinyl bag and port sites be excised or washed with normal saline to prevent port site recurrence in patients with laparoscopic cholecystectomy for pT2 or pT3 carcinoma.
评估腹腔镜胆囊切除术对意外发现及疑似胆囊癌的有效性。
回顾性研究，平均随访27个月，范围为1至47个月。
大学医院及8家附属医院。
在4年期间进行的2616例腹腔镜胆囊切除术中，24例胆囊癌患者接受了腹腔镜胆囊切除术并进行回顾性分析。
临床病程取决于胆囊癌的组织病理学浸润深度。所有6例病理肿瘤（pT）原位（pTis）胆囊癌及2例pT1胆囊癌均未侵犯淋巴管、静脉或神经周围间隙，这8例患者在腹腔镜胆囊切除术后2至19个月（平均11个月）均状况良好。16例pT2或pT3胆囊癌侵犯了浆膜下层或肝脏，16例患者中有5例分别在术后5天、7个月、12个月、15个月和18个月死于肝功能衰竭、腹部伤口复发或肝转移，尽管这5例患者中有4例在腹腔镜胆囊切除术后进行了肝床附加切除及淋巴结清扫。16例pT2或pT3胆囊癌患者中有3例（19%）在无远处转移的情况下出现腹壁复发，原因是胆囊或腹腔镜取出部位的腹部穿刺伤口接种了癌细胞。
腹腔镜切除的pTis或pT1期胆囊癌无需其他治疗。对于pT2或pT3期胆囊癌行腹腔镜胆囊切除术的患者，我们建议用塑料袋取出胆囊，并切除或用生理盐水冲洗穿刺孔部位，以预防穿刺孔部位复发。
