腹腔镜探查判断胆囊癌可切除性的临床意义

目的 初步评价腹腔镜探查在胆囊癌外科治疗中的应用价值.方法 自2007年1月至2010年3月在上海交大医学院附属新华医院普外科及第二军医大学东方肝胆外科医院腹腔镜科收治胆囊癌患者中,选择有手术切除可能的60例患者作为腹腔镜探查组,将同期符合相同条件行剖腹探查的192例胆囊癌患者作为对照组,比较两组手术切除率、腹腔广泛转移患者的手术时间及住院时间.计量资料采用t检验,计数资料采用x2检验.结果 腹腔镜探查组60例中27例患者的肝脏和(或)腹膜有肿瘤广泛转移,中止手术;33例转行剖腹探查,发现1例肝脏多处肿瘤转移、12例侵犯门静脉主干和(或)胰头、十二指肠,无手术切除可能,中止手术;其余20例中7例行胆囊癌姑息性切除,13例行胆囊癌根治性切除术.直接行剖腹探查组192例术中发现肝脏和(或)腹膜肿瘤广泛转移的82例及侵犯门脉主干和(或)胰头31例均中止手术,姑息性切除32例,根治性切除47例.两组手术切除率、腹腔广泛转移患者的手术时间及住院时间差异有统计学意义(x2=4.328,t=8.6501,t=5.8260;P＜0.05、P＜0.01、P＜0.01).结论 腹腔镜探查有助于手术决策的制定,减少不必要的非治疗性剖腹探查,能显著提高手术切除率,可以作为胆囊癌外科治疗中的常规操作.

Abstract：

Objective To evaluate the role of laparoscopic staging for the resectability of gallbladder cancer. Methods From Jan 2007 to Mar 2010,60 gallbladder cancer patients without of metastatic disease or main hepatic portal vessel invasion as assessed by preoperative imaging underwent staging laparoscopy for tumor resectability evaluation. Peritoneal and liver surface metastases were looked for and assessment of local spread was done if possible. Assessment was based on visual impression and biopsies were obtained routinely. T test and x2 test were used. Results At laparoscopy, 27 (45%) patients were found with disseminated disease on peritoneal cavity or the surface of liver, hence, senseless open surgery was avoided. The other 33 patients were converted to open laparotomy, among those 1 patient was found with disseminated metastasis in the liver and 12 patients with the invasion of main hepatic portal vessel,pancreatic head, duodenum did not undergo any further surgery. Finally 7 patients received surgical bypass procedure and 13 patients underwent radical resection. During the same period, 192 clinically diagnosed gallbladder cancer patients undergoing open laparotomy without laparoscopic pre-assessment served as control. Among those in control group 79 patients received radical or palliative resection. The resectability rate was significantly different between the two groups ( P ＜ 0. 05). Conclusion Staging laparoscopy in patients with gallbladder cancer is helpful in detecting liver and peritoneal metastases overlooked by preoperative imaging, avoiding unnecessary open explorations.

Role of laparoscopic staging in the resectability of gallbladder cancer

Objective To evaluate the role of laparoscopic staging for the resectability of gallbladder cancer. Methods From Jan 2007 to Mar 2010,60 gallbladder cancer patients without of metastatic disease or main hepatic portal vessel invasion as assessed by preoperative imaging underwent staging laparoscopy for tumor resectability evaluation. Peritoneal and liver surface metastases were looked for and assessment of local spread was done if possible. Assessment was based on visual impression and biopsies were obtained routinely. T test and x2 test were used. Results At laparoscopy, 27 (45%) patients were found with disseminated disease on peritoneal cavity or the surface of liver, hence, senseless open surgery was avoided. The other 33 patients were converted to open laparotomy, among those 1 patient was found with disseminated metastasis in the liver and 12 patients with the invasion of main hepatic portal vessel,pancreatic head, duodenum did not undergo any further surgery. Finally 7 patients received surgical bypass procedure and 13 patients underwent radical resection. During the same period, 192 clinically diagnosed gallbladder cancer patients undergoing open laparotomy without laparoscopic pre-assessment served as control. Among those in control group 79 patients received radical or palliative resection. The resectability rate was significantly different between the two groups ( P ＜ 0. 05). Conclusion Staging laparoscopy in patients with gallbladder cancer is helpful in detecting liver and peritoneal metastases overlooked by preoperative imaging, avoiding unnecessary open explorations.