由内而外。腹腔镜手术期间胆囊微穿孔可能会释放黏膜细胞。
From inside out. Microperforation of the gallbladder during laparoscopic surgery may liberate mucosal cells.
作者信息
Texler M L, King G, Hewett P J
机构信息
Department of Surgery, The Queen Elizabeth Hospital, Woodville Road, Woodville South, South Australia, Australia, 5011.
出版信息
Surg Endosc. 1998 Nov;12(11):1297-9. doi: 10.1007/s004649900844.
BACKGROUND
Port-side recurrence after laparoscopic surgery on known and unsuspected gastrointestinal malignancies has been reported. The mechanisms of this type of metastatic spread are poorly understood. For in situ malignancies, microperforation of the viscus by laparoscopic instruments may liberate cells to facilitate malignant cell movement.
METHODS
Twenty-three patients undergoing laparoscopic cholecystectomy for benign disease were prospectively studied. The laparoscopic fundal grasper was washed with sterile saline at the start and conclusion of surgery. These washings were examined for the presence of mucosal cells as evidence that gallbladder perforation occurred during the operation.
RESULTS
No mucosal cells were seen from washings at the start of surgery. Thirteen cases (56%) of perforation or attempted choledochogram were recorded during surgery. Four of these 13 washings contained mucosal cells. One washing was positive for mucosal cells in the absence of perforation or attempted choledochogram.
CONCLUSIONS
Microperforation of the gallbladder by laparoscopic instruments occurs during laparoscopic cholecystectomy.
背景
已有报道称，已知和未被怀疑的胃肠道恶性肿瘤患者在接受腹腔镜手术后出现肝门侧复发。这种转移扩散的机制尚不清楚。对于原位恶性肿瘤，腹腔镜器械对脏器的微穿孔可能会释放细胞，从而促进恶性细胞移动。
方法
对23例因良性疾病接受腹腔镜胆囊切除术的患者进行前瞻性研究。在手术开始和结束时，用无菌生理盐水冲洗腹腔镜底部抓钳。检查这些冲洗液中是否存在黏膜细胞，以此作为手术过程中胆囊穿孔的证据。
结果
手术开始时冲洗液中未见黏膜细胞。手术期间记录到13例（56%）穿孔或尝试进行胆管造影的病例。这13份冲洗液中有4份含有黏膜细胞。在没有穿孔或尝试进行胆管造影的情况下，有1份冲洗液的黏膜细胞呈阳性。
结论
腹腔镜胆囊切除术期间，腹腔镜器械会导致胆囊微穿孔。
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