Ohmura Y, Yokoyama N, Tanada M, Takiyama W, Takashima S
Department of Surgery, National Shikoku Cancer Center Hospital, Matsuyama, Japan.
Surg Today. 1999;29(1):71-5. doi: 10.1007/BF02482974.
Unexpected gallbladder carcinoma was identified in a 71-year-old woman after she underwent a laparoscopic cholecystectomy (LC) for symptomatic cholelithiasis. A subsequent laparotomy for a resection of the liver bed and a dissection of the lymph nodes around the hepatoduodenal ligament was done. Two and a half years later, the patient developed subcutaneous metastasis at the epigastric trocar site through which the gallbladder was removed. A third operation was thus performed, revealing no evidence of peritoneal dissemination, liver metastasis, or lymph node metastasis, and the abdominal wall mass was resected. The histological findings confirmed the diagnosis of metastatic carcinoma of the gallbladder. We recommend that when planning LC, the possibility of malignancy should thus be kept in mind. However, if there is any sign which does not completely exclude malignancy, such as a contracture or wall thickness of the gallbladder, LC should be performed by the abdominal wall lifting method and using a protective bag for the removal of the gallbladder.
一名71岁女性因有症状的胆结石接受腹腔镜胆囊切除术（LC）后，被确诊为意外胆囊癌。随后进行了剖腹手术，切除肝床并清扫肝十二指肠韧带周围淋巴结。两年半后，患者在切除胆囊的上腹部套管针部位出现皮下转移。因此进行了第三次手术，未发现腹膜播散、肝转移或淋巴结转移的证据，切除了腹壁肿块。组织学检查结果证实为胆囊转移癌。我们建议，在计划进行LC时，应牢记恶性肿瘤的可能性。然而，如果有任何不能完全排除恶性肿瘤的迹象，如胆囊挛缩或壁增厚，应采用腹壁提升法并使用保护袋进行胆囊切除的LC手术。
