Laparoscopic Approach for Suspected Early-Stage Gallbladder Carcinoma
Laparoscopic Approach for Suspected Early-Stage Gallbladder Carcinoma
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DOI：
10.1001/archsurg.2009.261
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发表时间：
2010-02-01
影响因子：
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通讯作者：
Lee, Kyoung-Ho
中科院分区：
文献类型：
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作者：
Cho, Jai Young;Han, Ho-Seong;Lee, Kyoung-Ho
目的：目的：探讨腹腔镜手术治疗可疑早期胆囊癌的可行性。设计、地点和患者：一所大学医院的前瞻性研究。从2004年5月10日至2007年10月9日，考虑采用腹腔镜方法治疗36例基于术前计算机断层扫描无肝脏侵犯的T2或以下疑似胆囊癌患者。为了进一步排除肝脏侵犯，术前还进行了内镜超声检查（US）和腹腔镜US。完成胆囊切除术后进行冷冻活检。如果发现癌，腹腔镜淋巴结清扫术进行。主要结果措施：可行性和手术outcome.Results：三例患者谁有肝侵犯内镜US接受开放手术。另外3例在腹腔镜超声检查中发现肝脏受侵的患者将其外科手术转为剖腹手术。最后，30例患者接受了腹腔镜手术。结合CT、内镜超声和腹腔镜超声，排除肝脏浸润的阴性预测值达到100%。对于12例在冷冻活检中发现良性病变的患者，完成了腹腔镜手术。其余18例胆囊癌患者接受了额外的腹腔镜淋巴结清扫术。腹腔镜淋巴结清扫术中1例因出血中转开腹，中位手术时间190 min，中位出血量50 mL。并发症发生率为16.7%，术后平均住院时间为4天。中位随访27个月后，所有18例接受腹腔镜淋巴结清扫术生存没有任何复发或转移的证据。结论：腹腔镜治疗是可行的，安全的，在选定的早期胆囊癌患者。
Objective: To determine the feasibility of the laparoscopic approach for treating suspected early-stage gallbladder carcinoma.Design, Setting, and Patients: Prospective study from a university hospital. From May 10, 2004, to October 9, 2007, the laparoscopic approach was considered for treating 36 patients with suspected gallbladder carcinoma at T2 or less without liver invasion based on the preoperative computed tomographic scan. To further exclude liver invasion, preoperative endoscopic ultrasonography ( US) and laparoscopic US were additionally performed. Frozen biopsy was performed after completing the cholecystectomy. If carcinoma was found, laparoscopic lymphadenectomy was performed.Main Outcome Measures: Feasibility and operative outcome.Results: Three patients who had liver invasion on endoscopic US underwent open surgery. An additional 3 patients who had liver invasion noted on laparoscopic US had their surgical procedure converted to laparotomy. Finally, 30 patients underwent a laparoscopic procedure. With combined computed tomography, endoscopic US, and laparoscopic US, the negative predictive value for excluding hepatic invasion reached 100%. For the 12 patients who had benign lesions noted on their frozen biopsies, their laparoscopic surgical procedure was completed. The remaining 18 patients who had gallbladder carcinoma underwent additional laparoscopic lymphadenectomy. During laparoscopic lymphadenectomy 1 conversion occurred owing to bleeding, the median operative time was 190 minutes, and the median blood loss was 50 mL. The complication rate was 16.7% and the median postoperative hospital stay was 4 days. After a median follow-up of 27 months, all 18 patients who underwent laparoscopic lymphadenectomy survived without any evidence of recurrence or metastasis.Conclusion: Laparoscopic treatment is feasible and safe in selected patients with early-stage gallbladder carcinoma.