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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 investigate the diagnosis and treatment of incision tumor after laparoscopic cholecystectomy (LC) and the preventive measures. Methods: A retrospective analysis of January 1994 to December 2003 after diagnosis and treatment of LC 12 cases of tumor implantation after the clinical data. RESULTS: LC 10 865 patients underwent incisional tumor implantation in 4 patients (0.037%), which showed a hard mass at the puncture of the xiphoid. The pathology was confirmed as metastatic adenocarcinoma, but the primary lesion could not be found. After the tumor was enlarged and resected, it was treated with local radiotherapy and systemic chemotherapy. The patients were followed up for 40, 20, 10 and 1 month respectively. One case died of tumor distant metastasis in March after the incision was found. One case was found after the xiphoid mass April umbilical cesarean section also see metastatic adenocarcinoma, surgical exploration of peritoneal tumor can be seen, the other two cases no tumor recurrence and metastasis. Conclusion: The incidence of incision tumor implantation after LC is low, but the prognosis is poor. The traditional gallbladder pathology can miss the primary tumor. To understand its clinical manifestations and pathogenesis, is conducive to better guide the clinical work.