腹腔镜胆囊切除术后切口肿瘤种植的临床分析

Clinical analysis of port site metastasis after laparoscopic cholecystectomy

目的:探讨腹腔镜胆囊切除术(LC)后切口肿瘤种植的诊断治疗及预防措施。方法:回顾分析1994年1月至2003年12月诊治LC术后切12肿瘤种植病例的临床资料。结果:LC 10 865例术后发生切口肿瘤种植4例(0.037％),表现为剑突下戳孔处质硬肿块,病理证实为转移性腺癌,但无法找到原发病灶。行肿块扩大切除后辅以局部放疗及全身化疗,分别随访40、20、10、1个月,1例在发现切口种植后3月因肿瘤远处转移死亡,1例在发现剑突下肿块后4月脐孔戳口处又见转移性腺癌,手术探查可见腹膜肿瘤种植,另2例未见肿瘤复发及转移。结论:LC术后切口肿瘤种植发生率低,但预后差,传统胆囊病理检查可漏诊原发癌灶。认识其临床表现与发病机制,有利于更好地指导临床工作。

Objective: To evaluate the diagnosis, treatment and prophylactic measures of the port site metastasis after laparoscopic cholecystectomy(LC) . Methods: A retrospective study was performed on 4 patients with port site metastasis from 10865 patients underwent LC from January 1994 to December 2003. Results: All four metastasis mass were resected with pathologically confirmed metastasis adenocarcinoma and local radiotherapy and systemic chemotherapy were further performed. All four patients were followed up 40,20,10 and 1 month respectively. 1 patient died of systemic tumor metastasis in 3 months after port site metastasis was diagnosed, 1 patient had another port site(umbilical port) and peritoneal metastasis after xiphoid metastasis was diagnosed, and other 2 patiends had no tumor recurrence and metastasis. Conclusions: The morbidity of port site metastasis after LC is very low and serial section may improve the diagnosis of potential gallbladder carcinoma which may lead to port site metastasis with poor prognosis.