腹腔镜初次及二次胆囊癌根治术的可行性

Feasibility of laparoscopic radical resection and re-resection for suspicious and incidental gallbladder cancer

目的探讨腹腔镜技术在胆囊癌初次及二次根治性手术中的可行性。方法检索PubMed等数据库,筛选并复习相关文献,从腹腔镜胆囊癌初次根治术能否达到开腹手术效果和是否能实现足够的淋巴结清扫范围,意外胆囊癌二次根治术的手术时机、能否通过腹腔镜完成二次根治术等方面进行综述。结果腹腔镜初次及二次胆囊癌根治术在理论上和技术上是可行的,但是在手术效果、二次手术时机等方面仍存在一定争议,其远期疗效需要多中心大宗病例进一步探讨。结论腹腔镜技术在初次及二次胆囊癌根治术的应用中展现了一定的前景,在腹腔镜经验丰富的中心可以进行尝试性探索,但是需要严格选择病例,保证达到开腹手术的效果是进行探索的原则。

Objective To evaluate feasibility of laparoscopic radical resection and re-resection for suspicious and incidental gallbladder cancer.Methods We searched PubMed and other databases,reviewed relevant literatures and summarized from aspects like whether efficacy comparable to laparotomy and enough lymph node dissection could be achieved through laparoscopy,timing of reoperation for incidental gallbladder cancer.Results Laparoscopic radical resection and re-resection were theoretically and technically feasible,but its efficacy and timing of re-resection were controversial,and its long-term efficacy needed further discussions in multi-center and large-scale cohort studies.Conclusions Laparoscopy shows prospects of resection and re-resection for suspicious and incidental gallbladder cancer.Tentative explorations could be done in properly selected patients by well-experience medical centers and to achieve efficacy comparable to laparotomy is the fundamental principle.