Laparoscopic cholecystectomy can disseminate in situ carcinoma of the gallbladder.
Laparoscopic cholecystectomy can disseminate in situ carcinoma of the gallbladder.
复制标题
腹腔镜胆囊切除术可导致胆囊原位癌播散。
DOI：
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发表时间：
1995
影响因子：
5.2
通讯作者：
C. H. Andrus
中科院分区：
文献类型：
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作者：
L. Wibbenmeyer;T. P. Wade;R. C. Chen;R. C. Meyer;R. Turgeon;C. H. Andrus
背景
早期病例报告显示，与开腹胆囊切除术相比，腹腔镜胆囊切除术(LC)后胆囊癌的复发更为频繁和迅速。这种癌症的预后很差，在接受胆囊切除术的患者中有1%会发生。
研究设计
本文回顾了社区医院近期收治的胆囊癌(GBC)，总结了LC术后GBC的全部报道经验。对GBC患者和24例因良性疾病行LC的患者的诊断结果进行了比较。
结果
928例患者中发现胆囊癌9例，发生率为0.97%。与没有胆囊癌的患者相比，癌症患者年龄更大，胆囊壁更厚，术中发现的异常更多(P<；OR=0.05)。与开腹胆囊切除术后的复发模式相比，LC后GBC的复发更快，并且发生在弥漫性腹膜和腹膜外口部位。
结论
对于胆囊癌患者，如果病变局限于胆囊壁粘膜，并且完整地切除了胆汁而没有胆汁外溢，LC可能就足够了。然而，在剥离过程中胆囊被撕裂的患者或患有侵袭性肿瘤的患者应该接受开腹手术和局部再次切除。如果在解剖过程中器官被撕裂，可以植入原位GBC。当LC发现可疑的胆囊壁增厚或粘连时，尤其是老年患者，应改行开腹胆囊切除术。
BACKGROUND
Early case reports suggest more frequent and rapid recurrences of carcinoma of the gallbladder after laparoscopic cholecystectomy (LC) than after open cholecystectomy. This cancer has a poor prognosis and occurs in 1 percent of patients who undergo cholecystectomies.
STUDY DESIGN
A recent community hospital series of gallbladder carcinoma (GBC) was reviewed and the total reported experience of GBC after LC was compiled. Diagnostic findings were compared for patients with GBC and a consecutive series of 24 patients who had LC for benign disease.
RESULTS
Nine patients with GBC were found among 928 patients who had undergone cholecystectomy (0.97 percent incidence). Compared to patients without GBC, patients with carcinoma were older, had thicker gallbladder walls, and had more abnormalities detected intraoperatively (all p < or = 0.05). Recurrence of GBC occurred more rapidly after LC, and in diffuse peritoneal and port sites when compared with recurrence patterns after open cholecystectomy.
CONCLUSIONS
In patients with GBC, LC may be sufficient when the disease is confined to the gallbladder mucosa and the gallbladder is excised intact without bile spillage. However, patients whose gallbladders are torn during dissection or patients who have invasive tumors should undergo laparotomy and local reexcision. In situ GBC can be implanted if the organ is torn during dissection. When gallbladders with suspicious wall thickening or adhesions are noted at LC, especially in older patients, the procedure should be converted to open cholecystectomy.