Tsuchida Akihiko, Itoi Takao, Endo Mitsufumi, Kitamura Keiichi, Mukaide Masahito, Itokawa Fumihide, Ozawa Takashi, Aoki Tatsuya
Department of Surgery, Tokyo Medical University, Tokyo 160-0023, Japan.
Oncol Rep. 2004 Feb;11(2):269-76.
In cases of pancreaticobiliary maljunction without dilatation of the extrahepatic bile duct (undilated PBM), preventive cholecystectomy is performed because there is a high incidence of gallbladder cancer as compared to cases of PBM with dilatation of the extrahepatic bile duct (dilated PBM). However, it is still controversial whether resection of the extrahepatic bile duct should also be performed in patients with undilated PBM. Accordingly, we analyzed pathological findings, postoperative complications and a long-term prognosis in 19 patients with undilated PBM to clarify the possibility of the bile duct cancer. In undilated PBM, hyperplasia was significantly recognized in the gallbladder as compared to the bile duct (p=0.0238), while no significant differences were found in other epithelium. Atypical epithelium and hyperplasia in gallbladder mucosa of undilated PBM were significantly recognized as compared to cases of pancreas or biliary tract cancer without PBM (p=0.0035, p=0.0019, respectively), while no significant differences were recognized in any kind of epithelium of the bile duct. In 14 cases of undilated PBM with preservation of the extrahepatic bile duct, the postoperative observation period was from 1 year and 5 months to 18 years and 10 months (mean: 8.3 years). One of the 5 patients with gallbladder cancer died 2 years and 6 months after surgery due to the cancer recurrence, while the remaining 13 patients had no complications such as liver dysfunction, cholangitis or remnant bile duct cancer, and the patients have survived in good health. These findings indicate that preventive bile duct resection is not necessary in patients with undilated PBM.
在肝外胆管未扩张的胰胆管合流异常（非扩张性PBM）病例中，由于与肝外胆管扩张的胰胆管合流异常（扩张性PBM）病例相比，胆囊癌的发生率较高，因此进行预防性胆囊切除术。然而，对于非扩张性PBM患者是否也应切除肝外胆管仍存在争议。因此，我们分析了19例非扩张性PBM患者的病理结果、术后并发症和长期预后，以阐明胆管癌的可能性。在非扩张性PBM中，与胆管相比，胆囊中增生明显（p = 0.0238），而在其他上皮中未发现显著差异。与无PBM的胰腺癌或胆管癌病例相比，非扩张性PBM胆囊黏膜中的非典型上皮和增生明显（分别为p = 0.0035，p = 0.0019），而在胆管的任何一种上皮中均未发现显著差异。在14例保留肝外胆管的非扩张性PBM病例中，术后观察期为1年5个月至18年10个月（平均：8.3年）。5例胆囊癌患者中有1例在术后2年6个月因癌症复发死亡，其余13例患者无肝功能障碍、胆管炎或残余胆管癌等并发症，且健康存活。这些发现表明，非扩张性PBM患者无需进行预防性胆管切除。
