Gerhards M F, Vos P, van Gulik T M, Rauws E A, Bosma A, Gouma D J
Departments of Surgery, Radiology, Gastroenterology and Pathology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
Br J Surg. 2001 Jan;88(1):48-51. doi: 10.1046/j.1365-2168.2001.01607.x.
The differentiation between benign and malignant strictures at the hepatic hilum is difficult. The aim of this study was to assess the clinical and radiographical features of hilar lesions in a series of patients resected for a presumed cholangiocarcinoma.
Of 132 consecutive patients undergoing resection for a suspicious lesion at the hepatic hilum, 20 (15 per cent) had a histopathologically proven benign tumour, diagnosed as chronic fibrosing or erosive inflammation, sclerosing cholangitis, or a granular cell tumour. All medical files and radiological examinations of the patients were reassessed.
Clinical symptoms were considered suspicious in 16 of 19 patients. At ultrasonography only one of 16 patients had an unsuspicious examination. In 14 of 18 patients cholangiographic images were considered suspicious. Overall reassessment confirmed a suspicious lesion in all 20 patients.
Because of the limitations of current diagnostic tools, a false-positive preoperative diagnosis of malignancy resulted in a 15 per cent resection rate of benign lesions in this series of suspicious hilar strictures.
肝门部良性和恶性狭窄的鉴别诊断较为困难。本研究旨在评估一系列因疑似胆管癌而接受手术切除的患者肝门部病变的临床和影像学特征。
在132例连续因肝门部可疑病变接受手术切除的患者中，20例（15%）经组织病理学证实为良性肿瘤，诊断为慢性纤维性或侵蚀性炎症、硬化性胆管炎或颗粒细胞瘤。对所有患者的病历和影像学检查进行了重新评估。
19例患者中有16例临床症状可疑。超声检查时，16例患者中仅1例检查结果无异常。18例患者中有14例胆管造影图像可疑。总体重新评估证实所有20例患者均存在可疑病变。
由于目前诊断工具的局限性，在这一系列可疑肝门部狭窄病例中，术前恶性肿瘤的假阳性诊断导致了15%的良性病变切除率。
