원발성 담낭암에 있어서 복강경검사의 의의 = Biliary Tract & Pancreas;Peritoneoscopy in Primary Gallbladder Cancer

다국어 초록 (Multilingual Abstract)

Primary gallbladder cancer is a highly malignant tumor and is characterized by early metastasis and rapid progression of disease. Since the majority of patients have unresectable disease, laparotomy, instead of providing relief of symptoms, often adds to the morbidity and needs to be avoided in patients with advanced disease.
Clinical features, peritoneoscopic findings, and comparison of peritoneoscopy with radiologic studies were reviewed in 29 patients, who underwent peritoneoscopy, with primary gallbladder cancer at Severaace Hospital, College of Medicine, Yonsei University between Aug. 1982 and Mar. 1994.
The results were as follows;
1) The ratio of male to female was 1.6 : 1 and the mean age was 57.9 years.
2) The most common presenting symptom and sign were abdaminal pain (72%) and palpable mass (49%), respectively. There were 7 cases (24.1%) who had no specific presenting sign.
3) The gallbladder was completely or partly seen in 22 patients and not seen in 7 due to adhesion under peritoneoscopy. Of visible 22 cases, the peritoneoscopic features in order of frequency were hard consistency (18 cases), tense cystic (13 cases), white thick wall (8 cases), and neovascularization (8 cases). There were 10 cases with intraabdominal metastasis to liver (2 cases) and peritoneum (8 cases).
4) Peritoneoscopic diagnosis were as follows; inoperable due to intraabdominal metastasis (10 cases), loco-regional (12 cases), and inconclusive (7 cases) due to invisible gallbladder without intraabdorninal metastasis (6 cases) and the possibility of benign disease (1 case, gallbladder anomaly).
5) Diagnostic accuracies of ultrasonography and camputerized tomography were 68.2%(15 of 22) and 88.9% (14 of 18), respectively.
6) The diagnostic methods in order of diagnostic accuracy for intraabdominal metastasis were peritoneoscopy (81.8%), computerized tomography (81.3%) and ultrasonography (73.3%), but, these differences were not significant.
7) Peritoneoscopic biopsies were performed in 14 cases and confirmations were done in 10 cases.
8) Surgical procedures were performed in l7 cases, including radical cholecystectomy in 8, simple cholecystectomy in 2 cases, cholecytectomy with T-tube choledochostomy in 5 cases, and exploratory laparotorny in 2 cases, in which one had liver metastasis.
9) There was no serious complication of peritoneoscopy.
These results suggest that peritoneoscopic evaluation is safe and useful method for diagnosis and staging of primary gallbladder cancer, and could prevent unnecessary surgery in patients with advanced disease by careful preoperative evaluation for pperability.