Sakamoto E, Hayakawa N, Kamiya J, Kondo S, Nagino M, Kanai M, Miyachi M, Uesaka K, Nimura Y
First Department of Surgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
World J Surg. 1999 Oct;23(10):1038-43; discussion 1043-4. doi: 10.1007/s002689900620.
Intrahepatic cholangiocarcinomas that secrete macroscopically excessive mucin into the biliary system are rare, and few of the previously reported cases have achieved a curative resection. We defined these tumors as "mucin-producing intrahepatic cholangiocarcinomas" and clarify the optimal preoperative and surgical management for them. Eleven patients with mucin-producing intrahepatic cholangiocarcinomas underwent surgical resection in our department. The clinical, radiologic, surgical, and pathologic findings were studied. The clinical presentation of the 11 patients included repeated abdominal pain, jaundice, and fever. Conventional cholangiographies, such as percutaneous transhepatic cholangiography or endoscopic retrograde cholangiography, could not offer precise information about tumor location and extension because of abundant mucin in the biliary system. Using percutaneous transhepatic biliary drainage (PTBD) and percutaneous transhepatic cholangioscopy (PTCS), we were able to drain the mucin and determine precisely the cancer extension into intrahepatic segmental bile ducts. Based on these findings, various types of liver resection with or without extrahepatic bile duct resection were planned, and 10 patients obtained curative resection. The cumulative 5-year survival rate after curative resection was 78%. In patients with mucin-producing intrahepatic cholangiocarcinoma, PTBD and PTCS are important for evaluating the cancer extension. Rational surgery based on accurate preoperative diagnosis improved the prognosis of patients with this disease.
向胆道系统分泌大量肉眼可见黏液的肝内胆管癌十分罕见，此前报道的病例中很少有实现根治性切除的。我们将这些肿瘤定义为“产黏液性肝内胆管癌”，并阐明针对它们的最佳术前及手术管理方法。我们科室有11例产黏液性肝内胆管癌患者接受了手术切除。对其临床、影像学、手术及病理结果进行了研究。这11例患者的临床表现包括反复腹痛、黄疸和发热。由于胆道系统内存在大量黏液，常规胆管造影，如经皮肝穿刺胆管造影或内镜逆行胆管造影，无法提供有关肿瘤位置及范围的精确信息。通过经皮肝穿刺胆道引流（PTBD）和经皮肝穿刺胆管镜检查（PTCS），我们能够引流黏液并精确确定癌肿向肝内段胆管的蔓延情况。基于这些发现，计划实施了各种类型的肝切除，包括是否联合肝外胆管切除，10例患者实现了根治性切除。根治性切除后的累积5年生存率为78%。对于产黏液性肝内胆管癌患者，PTBD和PTCS对于评估癌肿蔓延情况很重要。基于准确术前诊断的合理手术改善了该疾病患者的预后。
