Gunvén P, Gorsetman J, Ohlsén H, Rudén B I, Lundell G, Skoog L
Department of Surgery, Karolinska Hospital, S-171 76 Stockholm, Sweden.
Cancer. 2000 Jul 1;89(1):69-73. doi: 10.1002/1097-0142(20000701)89:1<69::aid-cncr10>3.0.co;2-9.
Biliary papillomatosis is rare and often fatal. Liver resection or transplantation is recommended but may be impossible due to tumor or patient factors; furthermore, it appears to the authors of this study that no follow-up results after transplantation have been reported in previous studies.
Bilobar but limited biliary papillomatosis in a man age 54 years was mapped by cholangiopancreatography, cholecystectomy, and operative cholangioscopy. After cholangioscopic electrocoagulation, iridium-192 wires were temporarily inserted into the affected bile ducts, giving a dose of 60 grays at a 3-mm distance. Another percutaneous cholangioscopic electrocoagulation was performed 3 weeks later.
The patient has been free of tumor and in good health for 80 months, but he has a long term stenting of a nonneoplastic stricture at the confluence of the bile ducts.
Mechanical tumor reduction and intraluminal brachytherapy could possibly replace transplantation (which up to now has been suggested but not reported) when this life-threatening disease is bilobar, and also possibly replace liver resection for limited tumors in patients who are too frail for surgery.
胆管乳头状瘤病罕见且往往致命。推荐进行肝切除或肝移植，但由于肿瘤或患者因素可能无法实施；此外，本研究作者发现既往研究中尚无肝移植术后的随访结果报道。
对一名54岁男性的双侧局限性胆管乳头状瘤病进行了胰胆管造影、胆囊切除术及术中胆管镜检查。在胆管镜下电凝后，将铱-192导线临时插入受累胆管，在距离3毫米处给予60格雷的剂量。3周后进行了另一次经皮胆管镜电凝。
该患者已无肿瘤且健康状况良好达80个月，但在胆管汇合处有一个非肿瘤性狭窄的长期支架置入。
当这种危及生命的疾病为双侧性时，机械性肿瘤减积和腔内近距离放疗可能替代肝移植（此前虽有建议但无报道），对于因身体过于虚弱而无法进行手术的局限性肿瘤患者，也可能替代肝切除。
