Watanabe Y, Toki A, Todani T
Department of Pediatric Surgery, Kagawa Medical University, 1750-1 Miki, Kita, Kagawa 761-0793, Japan.
J Hepatobiliary Pancreat Surg. 1999;6(3):207-12. doi: 10.1007/s005340050108.
Oncogenesis after cyst excision for choledochal cyst and suitable surgical procedures for this operation are discussed. The clinical data of 23 patients with cancer of the biliary tree after excision of choledochal cyst reported in the English-language and Japanese literature were reviewed, and data for 1353 Japanese patients with choledochal cyst and/or pancreaticobiliary malunion were analyzed. In the 23 patients reported in the literature, age at cyst excision ranged from 1 to 55 years (average, 23.0 +/- 13.7 years), and cancers were detected at age 18-60 years (average, 32.1 +/- 12.2 years), with intervals between cyst excision and cancer detection of 1-19 years (average, 9.0 +/- 5.5 years). Sites of cancer development were: intrahepatic, six; anastomotic, eight; hepatic side residual cyst, three; and the intrapancreatic duct, six. In the Japanese patients with choledochal cyst and/or pancreaticobiliary malunion, the incidence of cancer associated with primary choledochal cyst and/or pancreaticobiliary malunion was 16.2% (219/1353). The incidence of cancer development after cyst excision in this population, of whom 1291/1353 underwent surgery, was assumed to be 0. 7%. Nearly half of the 23 patients in the literature had undergone inadequate cyst excision. Oncogenesis of cancers after cyst excision is possibly different from that of choledochal cysts.
本文讨论了胆总管囊肿囊肿切除术后的肿瘤发生情况以及该手术适用的外科手术方式。回顾了英文和日文文献中报道的23例胆总管囊肿切除术后胆管癌患者的临床资料，并分析了1353例日本胆总管囊肿和/或胰胆管合流异常患者的数据。文献报道的23例患者中，囊肿切除时的年龄为1至55岁（平均23.0±13.7岁），癌症发现年龄为18至60岁（平均32.1±12.2岁），囊肿切除与癌症发现的间隔时间为1至19年（平均9.0±5.5年）。癌症发生部位为：肝内6例；吻合口8例；肝侧残余囊肿3例；胰内胆管6例。在日本胆总管囊肿和/或胰胆管合流异常患者中，原发性胆总管囊肿和/或胰胆管合流异常相关癌症的发生率为16.2%（219/1353）。该人群中囊肿切除术后癌症发生率，其中1291/1353例接受了手术，假定为0.7%。文献报道的23例患者中近一半囊肿切除不彻底。囊肿切除术后癌症的发生机制可能与胆总管囊肿不同。
