Yoon Yoo-Seok, Kim Sun-Whe, Jang Jin-Young, Park Yong-Hyun
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Hepatogastroenterology. 2005 Mar-Apr;52(62):381-4.
Local recurrence, following a resection for cancer of the extrahepatic bile duct, is usually incurable with second curative surgery being almost impossible. To determine the feasibility and significance of second curative surgery, our experiences are presented in this study. The medical records and clinical outcomes of two patients that underwent a re-resection for recurrent cancer of the extrahepatic bile duct were retrospectively reviewed. A 50-year-old female patient that had a recurrent disease at the intrahepatic and intrapancreatic bile duct, 66 months after a segmental resection of the bile duct for common bile duct (CBD) cancer, underwent a hepatopancreatoduodenectomy. A 29-year-old female patient had a recurrent tumor mass in the distal CBD, 28 months after a right hemihepatectomy and Roux-en-Y hepaticojejenostomy for a type IIIa Klatskin tumor, and underwent a segmental resection of the bile duct. The gross type of the above two cases was a papillary tumor. There was no operative mortality or morbidity. All patients are still alive after 46 and 9 months, respectively, without recurrence after the reoperation. It is concluded that a surgical re-resection is possible in selected patients with recurrent bile duct cancer, mostly of the papillary type. A primary operation for bile duct cancer should be performed with a wide surgical margin, and secondary curative surgery should be considered whenever possible in cases of recurrence.
肝外胆管癌切除术后的局部复发通常无法治愈，几乎不可能进行二次根治性手术。为了确定二次根治性手术的可行性和意义，本研究介绍了我们的经验。对两例接受肝外胆管复发癌再次切除术的患者的病历和临床结果进行了回顾性分析。一名50岁女性患者，在因胆总管癌行胆管节段切除术后66个月，肝内和胰内胆管出现复发性疾病，接受了胰十二指肠切除术。一名29岁女性患者，在因IIIa型Klatskin肿瘤行右半肝切除术和Roux-en-Y肝空肠吻合术后28个月，胆总管远端出现复发性肿瘤肿块，接受了胆管节段切除术。上述两例的大体类型均为乳头状肿瘤。无手术死亡或并发症。所有患者分别在术后46个月和9个月时仍存活，再次手术后无复发。结论是，对于部分复发的胆管癌患者，大多为乳头状类型，手术再次切除是可行的。胆管癌的初次手术应在较宽的手术切缘下进行，复发时应尽可能考虑二次根治性手术。
