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Diseases of the Gallbladder and Bile Ducts - part 5

Đối với ung thư túi mật được tìm thấy trong hoặc sau khi cắt bỏ túi mật nội soi, chúng tôi khuyên bạn nên excising các trang web cảng. Tỷ lệ các trang web cổng di căn đã được tìm thấy là từ 14 đến 16% độc lập từ mở rộng của bệnh ung thư túi mật | 168 Section 2 Diagnostic and therapeutic approaches for the biliary tree and gallbladder Figure 8.4 After transection the bile duct is elevated and separated from the hepatic artery and the portal vein. carefully reviewed by an experienced pathologist to evaluate the degree of tumor infiltration. The surgical approach depends on the depth of tumor invasion in the gallbladder wall and major liver resection might be necessary. If the tumor is limited to the mucosa carcinoma in situ a simple cholecystectomy is sufficient offering excellent longterm survival see Chapter 15 . If the tumor infiltrates the muscularis propria without reaching the gallbladder serosa an extended cholecystectomy gallbladder resection plus wedge resection of the liver with dissection of the lymphatic tissue of the hepatoduodenal ligament is the therapy of choice. Therefore the gallbladder plus a 1- to 3-cm wedge resection of the gallbladder bed are resected with a frozen section ofthe resection margin of cystic duct. If the intraoperative cystic duct biopsy is positive for tumor a complete resection of the choledochal duct and common hepatic duct up to the bifurcation with the surrounding lymphatic tissue has to be added to the procedure. For gallbladder carcinoma found during or after a laparoscopic cholecystectomy we recommend excising the port sites. The incidence of port sites metastases was found to be between 14 and 16 independent from the extend of the gallbladder cancer 29 30 . In addition in cases with gallbladder perforation during laparoscopic cholecystectomy the incidence of port site metastases has been as high as 40 . More extensive resections are indicated if the tumor extends beyond the gallbladder serosa. Extended right hemi-hepatectomy or central hepatectomy including segments IVb and V together with a resection of the cystic duct common bile duct and the lymphatic tissue are often used to achieve tumor clearance. The prognosis and results of the different approaches are .