Kobayashi S, Asano T, Yamasaki M, Kenmochi T, Nakagohri T, Ochiai T
Second Department of Surgery, Chiba University School of Medicine, Japan.
Surgery. 1999 Nov;126(5):939-44. doi: 10.1016/s0039-6060(99)70036-x.
A reflux of pancreatic juice into the biliary tract caused by pancreaticobiliary maljunction (PBM) has been considered important in the development of biliary tract carcinogenesis in choledochal cysts. We excised extrahepatic bile ducts in patients with choledochal cysts to terminate the reflux of pancreatic juice. We investigated whether this surgery could stop the development of the residual bile duct carcinoma.
Fifty-six patients with a diagnosis of PBM with choledochal dilatation underwent surgical excision of extrahepatic bile ducts. We applied a person-year method to compare the relative risks (observed number/expected number) of biliary tract carcinoma before and after surgery.
In 3 patients, bile duct carcinoma developed in residual dilated segments 19 years 6 months, 8 years 8 months, and 2 years 5 months, respectively, after surgery. Although the relative risk in the post-surgery group was slightly decreased by surgery, it was still high compared with that of the general population.
The incidence of bile duct carcinoma is still high, even after excision of extrahepatic bile ducts in PBM patients with choledochal dilatation. For these patients, careful long-term follow-up is necessary, especially after operations that leave the dilated bile ducts, such as cases of Todani's type IV-A.
胰胆管合流异常（PBM）导致的胰液反流至胆道，被认为在胆总管囊肿的胆道癌变发展过程中起重要作用。我们对胆总管囊肿患者切除肝外胆管以终止胰液反流。我们研究了该手术是否能阻止残余胆管癌的发生。
56例诊断为PBM合并胆总管扩张的患者接受了肝外胆管手术切除。我们采用人年法比较手术前后胆道癌的相对风险（观察数/预期数）。
3例患者分别在术后19年6个月、8年8个月和2年5个月时，残余扩张段发生胆管癌。尽管手术使术后组的相对风险略有降低，但与普通人群相比仍较高。
即使对PBM合并胆总管扩张的患者切除肝外胆管后，胆管癌的发生率仍然很高。对于这些患者，尤其是在像Todani IV - A型病例那样留下扩张胆管的手术后，需要进行仔细的长期随访。
