Ogura Y, Tabata M, Kawarada Y, Mizumoto R
First Department of Surgery, Mie University School of Medicine, Japan.
World J Surg. 1998 Mar;22(3):262-6; discussion 266-7. doi: 10.1007/s002689900380.
The purpose of this study was to assess the patterns of hepatic invasion in advanced carcinoma of the gallbladder by histologically examining surgical specimens obtained in 32 cases of hepatectomy for that carcinoma. Two modes of microscopic tumor extension were observed. The expansive pattern was restricted to liver-bed carcinomas, in which the tumor extends into the liver, primarily from the liver bed. Most of the infiltrating patterns were found with hepatic-hilar carcinomas, in which the tumor invades the hepatic hilum along Glisson's sheath, especially tumors exhibiting a discontinuous front of tumor invasion. The average width for wedge resection of the liver bed was 15.6 +/- 2.9 mm, in contrast to 25.6 +/- 8.1 mm for resection of segments IVa and V and 44.1 +/- 10.3 mm for extensive hepatic resection (both p < 0.01). When the hepatic invasion distance is more than 20 mm, the tumor should be selectively managed by extensive hepatic resection, such as extended right hepatic lobectomy or central bisegmentectomy. The results suggest that wedge resection of the liver bed and resection of segments IVa and V are advisable for carcinoma localized to the gallbladder alone and for liver-bed carcinoma with slight hepatic invasion and an expansive tumor growth pattern. Extensive hepatic resection, however, is recommended for carcinoma of the invasive liver-bed type and carcinoma of the hepatic-hilar type.
本研究旨在通过对32例因胆囊癌行肝切除术的手术标本进行组织学检查，评估晚期胆囊癌肝侵犯的模式。观察到两种微观肿瘤扩展模式。膨胀性模式仅限于肝床癌，肿瘤主要从肝床向肝脏扩展。大多数浸润性模式见于肝门部癌，肿瘤沿Glisson鞘侵犯肝门，尤其是肿瘤侵犯前沿呈间断性的肿瘤。肝床楔形切除的平均宽度为15.6±2.9mm，而IVa段和V段切除的平均宽度为25.6±8.1mm，广泛肝切除的平均宽度为44.1±10.3mm（两者p均<0.01）。当肝侵犯距离超过20mm时，应选择性地采用广泛肝切除术进行治疗，如扩大右肝叶切除术或中央双段切除术。结果表明，对于仅局限于胆囊的癌以及肝侵犯轻微且肿瘤呈膨胀性生长模式的肝床癌，肝床楔形切除及IVa段和V段切除是可取的。然而，对于浸润性肝床型癌和肝门型癌，建议行广泛肝切除术。
