Kim J S, Lee Y C, Chung B W, Chung K S, Lee Y J
Department of Surgery, Hallym University, Seoul, Korea.
Surg Laparosc Endosc. 1996 Feb;6(1):32-4.
Laparoscopic cholecystectomy has been rapidly adopted as a standard surgical treatment in symptomatic cholelithiasis. Its advantages over laparotomy are well described. However, its risks and long-term results have not been fully evaluated. We experienced three patients in whom intra-abdominal carcinomas failed to be recognized during laparoscopic surgery. The clinical manifestations, laboratory findings, and radiologic findings were carefully reviewed in each case. Limited exploration of the abdominal cavity is one of the technical pitfalls in laparoscopic cholecystectomy; so surgeons can miss the carcinoma of extrabiliary system. To prevent such problems, a careful taking of the history and physical examination should be repeated by the responsible surgeon, who must be aware of the differential diagnosis of cholelithiasis, especially in elderly patients. If needed, additional radiologic studies are recommended.
腹腔镜胆囊切除术已迅速成为有症状胆结石的标准外科治疗方法。其相对于剖腹手术的优势已得到充分描述。然而，其风险和长期结果尚未得到充分评估。我们遇到了3例患者，在腹腔镜手术期间未能识别出腹腔内癌症。对每个病例的临床表现、实验室检查结果和影像学检查结果进行了仔细回顾。腹腔有限探查是腹腔镜胆囊切除术的技术陷阱之一；因此外科医生可能会漏诊胆道外系统的癌症。为防止出现此类问题，负责的外科医生应反复仔细询问病史并进行体格检查，必须了解胆结石的鉴别诊断，尤其是在老年患者中。如有必要，建议进行额外的影像学检查。
