27 KB143 KB27 KB200520132006Malavašič, RokMušič, MarkSever, Markoletnik:11številka:258 stranistr. 57-64ISSN:1318-8941COBISSID:21317593URN:URN:NBN:SI:doc-5Q4CC8FKslSlovensko zdravniško društvoEndoskopska revijaCholecystectomy, LaparoscopicdiagnostikaGallbladder NeoplasmsHolecistoktemija laparoskopskakarcinomlaparoskopijatherapyTreatment OutcomezdravljenjeZdravljenje, izidžolčnikŽolčnik, novotvorbeNepričakovani karcinom žolčnika in postopki pri laparoskopski holecistektomiji| Incidental carcinoma of the gallbladder and proceedings during laparoscopic cholecystectomy|Background. An estimated one percent of patients operated on for symptomatic gallstones harbour an occult adenocarcinoma. The therapy for incidental carcinoma is based on histopathological staging, which underscores the key role of pathologists in cancer management. Aim. In order to amend the diagnostic and therapeutic standards followed, outcomes of patients treated atthis Department were compared wi.th the results reported by other authors. Patients and Methods. In the past four years (2001-2004), 1,437 patients underwent surgery,for symptoma.tic gallstones at this Department. All gallbladders were sent , for histopathological examination. Carcinoma of tlze gallbladder was diagnosed in seven patients. In one case, incidental carcinomawas found after laparoscopic cholecystectomy, and in four, after coventional surgery. In one of the remaining patients an i.noperable tumor wasdiscovered during laparoscopy. The diagnosis was confirmed by biopsy. Another patient, in whom carcinoma was suspected on the basis of history and ultrasound examination, had a standard operation, which revealed advanced disease with diffuse liver metastases. Results. Postoperative survival ranged from 1 to 15 months. An 85-year-old women was alive at the time of reporting, i.e. at four years after standard cholecystectomy combined with removal of gallstones from the choledochal duct. Postoperative patolzistological examination revealed an occult carcinoma (S1 (pT2) - AJCC/UICC TNM classification). Conclusions. Whenever gallbladder carcinoma is suspected on the basis of history and ultrasound examination, the patient should have a tumor marker assay and additional diagnostic procedures, such as CT and MR imaging. Better survival is expected in patients in whom the diagnosis has been established preoperatively. (Abstract truncated at 2000 characters)Izhodišča. Ocenjuje se, da ima okoli 1% vseh holecistektomiranih bolnikov (zaradi kalkuloze žolčnika) okultni karcinom. Zdravljenje je odvisno od stadija tumorja - vloga patologa. Cilji. Želeli smo osvežiti smernice, ki jih uporabljamo med zdravljenjem bolnikov s karcinomom žolčnika. V ta namen smo pregledali podatke za bolnike, ki so bili operirani pri nas, in rezultate primerjali z rezultati drugih avtorjev. Bolniki in metode. V zadnjih štirih letih (2001-2004) smo na našem kirurškem oddelku naredili 1437 holecistektomij. Na histološki pregled pošljemo vse odstranjene žolčnike. V tej skupini smo imeli 7 bolnikov s karcinomom žolčnika. Le en nepričakovani karcinom smo ugotovili po laparoskopski holecistektomiji. Štirikrat je bila diagnoza naključnega karcinoma postavljena po klasični operaciji in odstranitvi žolčnika. V preostalih dveh primerih smo enkrat z laparoskopijo ugotovili inoperabilni tumor. Naredili smo biopsijo, ki je diagnozo potrdila. Enkrat pa smo pristopili klasično zaradi sumljivega UZ izvida in anamneze; ugotovili smo razširjeno bolezen z difuznimi zasevki v jetrih. Rezultat. Preživetje po operaciji in diagnozi bolezni je bilo med 1 in 15 mesecev. Sedaj85-letna bolnica pa živi že štiri leta po klasični holecistektomiji in odstranitvi kamnov iz glavnega žolčevoda, po kateri je histologija pokazala, da gre za adenokarcinom žolčnika (naključni karcinom stadij S2 (pT2) po klasifikaciji AJCC/UICC TNM). Zaključki. Pri sumljivi anamnezi ali UZ izvidu je priporočljivo določiti tumorske označevalce in opraviti dodatne slikovne preiskave (CT, MR). Boljše preživetje imajo bolniki, pri katerih je diagnoza postavljena pred posegom in so radikalno operirani v prvi operaciji (napoved izida se pri naslednji operaciji poslabša). Holecistektomija kot radikalna operacija zadostuje le pri stadiju S1 (Tis, T1). Pri laparaskopski operaciji je potrebna atravmatska tehnika in pazljivo prepariranje v ležišču. (Izvleček skrajšan pri 2000 znakih)TEXTznanstveno časopisjejournalsSlovenian National E-content AggregatorNational and University Library of SloveniaSlovensko zdravniško društvo, Združenje za endoskopsko kirurgijo