Ricardo A E, Feig B W, Ellis L M, Hunt K K, Curley S A, MacFadyen B V, Mansfield P F
Department of Surgery, The University of Texas Medical School at Houston, USA.
Am J Surg. 1997 Dec;174(6):619-22; discussion 622-3. doi: 10.1016/s0002-9610(97)00178-5.
Critics of laparoscopic surgery cite an increased incidence of tumor recurrence at the trocar sites following laparoscopic cholecystectomy in patients incidentally found to have carcinoma of the gallbladder. The purpose of this review was to determine if laparoscopic cholecystectomy performed in patients with gallbladder cancer results in an increased incidence of abdominal wall recurrences.
The charts of all patients with gallbladder cancer registered at the University of Texas M. D. Anderson Cancer Center from January 1991 through April 1996 were retrospectively reviewed. Data were collected on initial and subsequent surgical procedures, tumor grade and histology, T stage, adjuvant therapy, and survival. These data were analyzed with regard to abdominal wall recurrences and outcome.
Ninety-three patients with gallbladder cancer were seen during this period; 79 patients with complete follow-up information comprised the study population. Comparison of the incidence of abdominal wall recurrences among the categories of surgical procedure (laparoscopic versus open versus laparoscopic converted to open) did not reveal any statistically significant differences. Overall 5-year survival was 10%.
Gallbladder cancer is an aggressive malignancy with few long-term survivors. In addition, these data show that the incidence of abdominal wall implantation is not increased with laparoscopic surgery but is more likely a manifestation of the aggressive nature of this tumor.
腹腔镜手术的批评者指出，在偶然发现患有胆囊癌的患者中，腹腔镜胆囊切除术后套管针穿刺部位肿瘤复发的发生率有所增加。本综述的目的是确定胆囊癌患者进行腹腔镜胆囊切除术后腹壁复发的发生率是否会增加。
回顾性分析了1991年1月至1996年4月在德克萨斯大学MD安德森癌症中心登记的所有胆囊癌患者的病历。收集了有关初次及后续手术、肿瘤分级和组织学、T分期、辅助治疗及生存情况的数据。对这些数据进行了腹壁复发及预后方面的分析。
在此期间共诊治了93例胆囊癌患者；79例有完整随访信息的患者构成了研究人群。对不同手术方式（腹腔镜手术、开放手术、腹腔镜中转开放手术）的腹壁复发发生率进行比较，未发现任何统计学上的显著差异。总体5年生存率为10%。
胆囊癌是一种侵袭性恶性肿瘤，长期存活者很少。此外，这些数据表明，腹腔镜手术不会增加腹壁种植的发生率，而更可能是这种肿瘤侵袭性本质的一种表现。
