Kaido Toshimi, Imamura Masayuki
Department of Surgery and Surgical Basic Science, Kyoto University Graduate School of Medicine Kyoto, Japan.
Hepatogastroenterology. 2005 May-Jun;52(63):725-7.
A 68-year-old woman was referred to our hospital with liver dysfunction. Abdominal ultrasonography showed an isoechoic mass in the hepatic hilum. Abdominal computed tomography (CT) disclosed a homogenous mass adjacent to the portal bifurcation, and endoscopic retrograde choledocho-pancreatography (ERCP) revealed complete obstruction from the common hepatic duct to the hepatic duct confluence. After insertion of the endoscopic nasobiliary drainage (ENBD) tube, laparotomy was performed, revealing an approximately 5x6-cm elastic hard mass at the hepatic hilum, mainly spreading to the left hepatic duct, and involving surrounding vascular structures such as the portal vein and right and left hepatic arteries. Therefore, she was treated by external radiation therapy (ERT) of 60 Gy in 30 sessions after insertion of endoscopic retrograde biliary drainage (ERBD) tubes to bilateral hepatic ducts to replace the ENBD tube. After the completion of ERT, she was discharged from the hospital in good health. Three months later, she was readmitted for cholangitis and received antibiotic treatment. Surprisingly, abdominal CT disclosed complete remission of the tumor. ERCP revealed patency of the common hepatic duct and hepatic duct confluence. Therefore, the ERBD tubes were removed. Specimens from the hepatic duct confluence, and bilateral hepatic ducts showed no malignancy histologically. She is doing well without recurrence more than 4 years after surgery.
一名68岁女性因肝功能障碍转诊至我院。腹部超声检查显示肝门处有一个等回声肿块。腹部计算机断层扫描（CT）显示门静脉分叉处附近有一个均匀的肿块，内镜逆行胰胆管造影（ERCP）显示从肝总管到肝管汇合处完全阻塞。插入内镜鼻胆管引流（ENBD）管后，进行了剖腹手术，发现肝门处有一个约5×6厘米的弹性硬块，主要蔓延至左肝管，并累及周围血管结构，如门静脉以及左右肝动脉。因此，在向双侧肝管插入内镜逆行胆管引流（ERBD）管以替代ENBD管后，她接受了30次共60 Gy的外照射治疗（ERT）。ERT完成后，她健康出院。三个月后，她因胆管炎再次入院并接受了抗生素治疗。令人惊讶的是，腹部CT显示肿瘤完全缓解。ERCP显示肝总管和肝管汇合处通畅。因此，ERBD管被拔除。肝管汇合处及双侧肝管的标本在组织学上未显示恶性肿瘤。手术后4年多来，她情况良好，无复发。
