Clayton R A E, Clarke D L, Currie E J, Madhavan K K, Parks R W, Garden O J
Department of Clinical and Surgical Sciences (Surgery) Royal Infirmary of Edinburgh.
Surgeon. 2003 Feb;1(1):32-8. doi: 10.1016/s1479-666x(03)80006-9.
Confirming the presence of hepatic or proximal bile duct malignancy pre-operatively remains difficult and some patients may undergo surgical resection for suspected malignant lesions which subsequently turn out to be benign. The aim of this study was to establish whether improvements in pre-operative staging might better identify this patient population.
Analysis of a prospectively collected database, which has been maintained in our unit since 1988.
Of 250 consecutive patients undergoing hepatic resection for presumed malignancy, 18 (7.2%) were shown to have benign pathology. These "false positive" rates were 4 out of 160 (2.5%) resections for colorectal metastases, 4 out of 49 (8.2%) resections for other solid hepatobiliary tumours and 10 out of 41 (24.4%) resections for hilar cholangiocarcinoma. Four of the 18 patients (22%) developed post-operative complications but there was no postoperative mortality.
Although hepatic resection remains a potentially curative procedure for patients with tumours involving the liver parenchyma or proximal bile ducts, pre-operative confirmation of malignancy remains difficult. Despite appropriate investigation a subset of patients with benign disease will still be subjected to major hepatic resection which should be undertaken in a specialist unit.
术前确诊肝或近端胆管恶性肿瘤仍然困难，一些患者可能因怀疑恶性病变而接受手术切除，结果后来发现病变是良性的。本研究的目的是确定术前分期的改善是否能更好地识别这类患者群体。
分析自1988年起在我们科室维护的前瞻性收集数据库。
在250例因疑似恶性肿瘤接受肝切除的连续患者中，18例（7.2%）病理显示为良性。这些“假阳性”率在因结直肠癌转移行肝切除的160例中有4例（2.5%），因其他实体性肝胆肿瘤行肝切除的49例中有4例（8.2%），因肝门胆管癌行肝切除的41例中有10例（24.4%）。18例患者中有4例（22%）发生术后并发症，但无术后死亡病例。
尽管肝切除对累及肝实质或近端胆管的肿瘤患者仍是一种潜在的治愈性手术，但术前确诊恶性肿瘤仍然困难。尽管进行了适当的检查，仍有一部分良性疾病患者会接受大型肝切除，此类手术应在专科单位进行。
