Koffron Alan, Rao Sambasiva, Ferrario Mario, Abecassis Michael
Department of Surgery, Northwestern University Medical School, Chicago, IL, USA.
Surgery. 2004 Oct;136(4):926-36. doi: 10.1016/j.surg.2004.06.031.
Recent interest in cyst fluid analysis (CFA) for carbohydrate antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA), and the introduction of laparoscopic surgery (LS) in the management of hepatic cysts have resulted in sporadic reports of elevated CA 19-9 and CEA levels in intrahepatic biliary cystadenoma (IBC) CFA, and the application of LS in the management of simple cysts. However, the role of CA 19-9 and CEA in the diagnosis of IBC and the role of LS in the management of IBC have not been previously defined.
We studied 34 patients with IBC at a single institution (8 years). The first 12 patients with IBC were managed with open surgical intervention. We subsequently developed a diagnostic and treatment algorithm for IBC that included, in the last 22 patients, prospective analysis of CFA for CA 19-9 and CEA, and LS for management
All patients with IBC who underwent CFA had elevated CA 19-9 (range, 2247-1,757,510; N <33 U/mL) and mildly elevated CEA (range, 3.3-212,; N <3 ng/ml). In all 22 patients the cyst lining consisted of biliary epithelium +/- mesenchymal stroma (MS). In 1/22 patients (highest CA 19-9 level), the cyst epithelium did not contain either MS or intestinal metaplasia. In contrast, control patients (simple cysts, n=8) had normal CFA. In the previous 12 patients managed with laparotomy, 6/12 patients had biliary epithelium alone; the other 6 also contained MS with 1 patient exhibiting intestinal metaplasia and cystadenocarcinoma.
We have proposed a management algorithm for IBC that incorporates CFA and laproscopic surgical management that allows for selective minimally invasive cyst wall sampling for patients with IBC.
近期对肝囊肿管理中碳水化合物抗原19-9（CA 19-9）和癌胚抗原（CEA）的囊液分析（CFA）的关注，以及腹腔镜手术（LS）在肝囊肿管理中的应用，导致了关于肝内胆管囊腺瘤（IBC）CFA中CA 19-9和CEA水平升高以及LS在单纯囊肿管理中的应用的零星报道。然而，CA 19-9和CEA在IBC诊断中的作用以及LS在IBC管理中的作用此前尚未明确。
我们在单一机构对34例IBC患者进行了为期8年的研究。最初的12例IBC患者接受了开放手术干预。随后，我们为IBC制定了一种诊断和治疗算法，在最后22例患者中，包括对CA 19-9和CEA进行CFA的前瞻性分析，以及采用LS进行管理。
所有接受CFA的IBC患者CA 19-9均升高（范围为2247 - 1,757,510；正常<33 U/mL），CEA轻度升高（范围为3.3 - 212；正常<3 ng/ml）。在所有22例患者中，囊肿内衬由胆管上皮+/-间充质基质（MS）组成。在1/22例患者（CA 19-9水平最高）中，囊肿上皮既不包含MS也不包含肠化生。相比之下，对照患者（单纯囊肿，n = 8）的CFA正常。在之前接受剖腹手术的12例患者中，6/12例患者仅有胆管上皮；另外6例还包含MS，其中1例患者表现出肠化生和囊腺癌。
我们提出了一种IBC管理算法，该算法结合了CFA和腹腔镜手术管理，允许对IBC患者进行选择性微创囊肿壁采样。
