中国实用外科杂志

中国实用外科杂志

• 专题笔谈 • 上一篇    下一篇

腹腔镜技术在胆囊癌根治术中的应用评价

陈亚进，徐鋆耀   

  1. 中山大学孙逸仙纪念医院肝胆外科，广东广州510120
  • 出版日期:2016-10-01 发布日期:2016-09-28

  • Online:2016-10-01 Published:2016-09-28

摘要：

在腹腔镜技术被广泛应用于各种胆道良性疾病诊治的当今，胆囊癌诊治的微创化进程尚非常缓慢，主要应用仍然集中在腹腔镜探查、腹腔镜下超声检查进一步术中分期以及晚期病人的腹腔镜下短路手术方面。针对胆囊癌的根治性切除，早期的少数尝试所致的不良预后使得其一度被列入腹腔镜手术的禁忌证。诚然，良性疾病只需克服技术上的瓶颈，而恶性疾病更要兼顾肿瘤预后。但近来的国际多中心前瞻性随机对照研究结果已经证实：完全腹腔镜途径治疗胃癌、结直肠癌等其他消化道恶性肿瘤不仅能在肿瘤学上与传统开腹途径具有可比性，还能带来微创化的优势。然而回顾其发展历史，早期亦饱受肿瘤学疗效的拷问。因此，腹腔镜技术在胆囊癌诊治中的作用仍待更多的临床研究及长期随访总结。

关键词: 胆囊癌, 腹腔镜, TNM分期, 淋巴结清扫术

Abstract:

Laparoscopic approach for the management of gallbladder cancer        CHEN Ya-jin，XU Jun-yao. Department of Hepatobiliary Surgery，Sun Yat-sen Memorial Hospital，Sun Yat-sen University, Guangzhou 510120，China
Corresponding author：CHEN Ya-jin，E-mail：cyj0509@
126.com
Abstract    Given the minimal invasive advantage over traditional open surgery, totally laparoscopic or robotic approach has been applied intensively in the surgical management of benign biliary diseases. In regards of gallbladder cancer, staging laparoscopy (plus EUS detection if available) has been shown a potential role in preventing non-therapeutic extensive resections for late-stage patients. Moreover, laparoscopically palliative bypass in locally advanced or metastatic disease has been shown to decrease postoperative hospital stay. However, traditionally, curative laparoscopic surgery has been contraindicated in patients with suspected gallbladder cancer. Although the management of malignant disease should consider oncological outcome as well as technical feasibility, recent reports from multiple RCT clinical study showed the great advantage of laparoscopic approach in various gastrointestinal cancers including gastric cancer and colorectal cancer, with comparable long term survival and fast postoperative recovery.  Since the very beginning,  doubt about the application of laparoscopic surgery on treatment of malignant diseases never stopped.

Key words: gallbladder cancer, laparoscopy, TNM staging system, lymph node dissection