Cimaschi D, De Cesare V, Pulcini G, Cervi E, Belloni M, Liserre B, Cervi G C
Azienda Ospedaliera Ospedali Civili di Brescia, Presidio di Gardone Val Trompia, Unità Operativa di Chirurgia Generale, Università degli Studi di Brescia, Italy.
G Chir. 2006 Jan-Feb;27(1-2):31-6.
We report a case of neuroma of the common hepatic duct arising five years after cholecystectomy (laparoscopic then converted in laparotomy). A 73-years-old patient was admitted for obstructive jaundice. Ultrasonography, TC and cholangiography showed a nodular lesion of the common hepatic of 1 cm in diameter, causing a regular and important stenosis of the main bile duct. Histologic examination demonstrated neuroma. By the analysis of this and 42 other previously published cases, the following features of bile duct neuroma were outlined: 1) variable interval between cholecystectomy and the onset of jaundice (2 months to 40 years); 2) the same incidence after laparoscopic or laparotomic cholecystectomy; 3) the generally complicated postoperative course after first surgical approach; 4) the various localizations on the biliary tree (cystic, main bile duct, intrahepatic ducts); 5) the circumstances of onset are almost the same (obstructive jaundice); 6) the histologic examination is mandatory for a correct diagnosis; and 7) the best treatment is resection of the bile duct tract involved in neuroma and reconstruction of biliary tree with hepaticojejunostomy.
我们报告一例胆囊切除术后(先腹腔镜手术,后转为开腹手术)五年出现的肝总管神经瘤病例。一名73岁患者因梗阻性黄疸入院。超声、CT和胆管造影显示肝总管有一个直径1厘米的结节性病变,导致胆总管出现规则且严重的狭窄。组织学检查证实为神经瘤。通过对该病例及其他42例先前发表病例的分析,总结出胆管神经瘤的以下特征:1)胆囊切除术后至黄疸出现的间隔时间不一(2个月至40年);2)腹腔镜或开腹胆囊切除术后发病率相同;3)首次手术入路后术后病程通常复杂;4)在胆道系统的不同部位(胆囊管、胆总管、肝内胆管)均有发生;5)发病情况基本相同(梗阻性黄疸);6)正确诊断必须进行组织学检查;7)最佳治疗方法是切除累及神经瘤的胆管段,并采用肝管空肠吻合术重建胆道系统。