Cotlar A M, Mueller C R, Pettit J W, Schmidt E R, Villar H V
Department of Surgery, Davis-Monthan Air Force Base, Arizona, USA.
J Laparoendosc Surg. 1996 Feb;6(1):35-45. doi: 10.1089/lps.1996.6.35.
There are increasing reports of seeding of tumor at the trocar sites following laparoscopic cholecystectomy in patients with unexpected or inapparent gallbladder carcinoma. A patient is reported here whose primary tumor appeared controlled by surgery and radiation, but who died of the disease after developing implant metastases at three untreated trocar sites. The second case report illustrates the difficulty in identifying gallbladder cancer during laparoscopic cholecystectomy, and the importance of a diligent preoperative effort to establish the diagnosis. Current literature suggests that tumor implantation occurring during laparoscopic cholecystectomy for inapparent carcinoma adversely affects prognosis, and, until the effect of laparoscopy on the spread of this tumor is better understood and controlled, open operation should be performed when carcinoma of the gallbladder is suspected. When laparoscopic cholecystectomy is done for inapparent gallbladder cancer, surgical and adjuvant radiotherapy to the trocar sites appears to improve outcome in association with extended treatment to the gallbladder bed and adjacent areas. Recent reports suggest that progress in diagnostic, surgical, and adjuvant techniques could substantially improve survival in carcinoma of the gallbladder.
越来越多的报告指出，在患有意外或隐匿性胆囊癌的患者中，腹腔镜胆囊切除术后套管针穿刺部位出现肿瘤种植。本文报告了一名患者，其原发性肿瘤似乎通过手术和放疗得到了控制，但在三个未经处理的套管针穿刺部位出现种植转移后死于该疾病。第二例病例报告说明了在腹腔镜胆囊切除术中识别胆囊癌的困难，以及术前认真努力确立诊断的重要性。当前文献表明，在腹腔镜胆囊切除术期间因隐匿性癌发生的肿瘤种植会对预后产生不利影响，并且在更好地理解和控制腹腔镜对这种肿瘤扩散的影响之前，当怀疑有胆囊癌时应进行开放手术。当为隐匿性胆囊癌进行腹腔镜胆囊切除术时，对套管针穿刺部位进行手术和辅助放疗，与对胆囊床及相邻区域的扩大治疗相结合，似乎可以改善预后。最近的报告表明，诊断、手术和辅助技术的进展可以显著提高胆囊癌患者的生存率。
