Nikhinson R A, Dykhno Iu A, KryzhanovskiI A I
Vopr Onkol. 1990;36(12):1488-93.
Data on 148 cases of cancer of the gallbladder and extrahepatic bile ducts were studied. Jaundice proved the cardinal symptom. No clear-cut clinical picture of the disease was identified. Diagnostic procedure should start with ultrasonography. Cholangiectasia and the enlarged pancreatic head make the case for fiber bronchoscopy and hypotonic duodenography. Cancer-negative patients should further undergo transcutaneous transhepatic cholangiography and, if proving still negative, retrograde cholangiopancreatography. Resection of bile ducts with simultaneous lymphadenectomy is considered radical. The authors suggest a surgical procedure for cancer of the gallbladder which includes resection of the liver, hepatico-choledoctomy and cholecystectomy with formation of cholangio-jejuno-anastomosis using disposable transhepatic drains. Recanalization of bile ducts by transhepatic drain is considered optimal for palliation. Survival depends upon extent of surgery and level of bile duct obstruction.
对148例胆囊癌和肝外胆管癌病例的数据进行了研究。黄疸是主要症状。未发现明确的疾病临床表现。诊断程序应从超声检查开始。胆管扩张和胰头肿大提示应进行纤维支气管镜检查和低张十二指肠造影。癌症阴性患者应进一步接受经皮经肝胆管造影术，如仍为阴性，则应进行逆行胰胆管造影术。胆管切除并同时进行淋巴结清扫术被认为是根治性的。作者建议一种胆囊癌的手术方法，包括肝切除、肝总管切除术和胆囊切除术，并使用一次性经肝引流管形成胆管空肠吻合术。经肝引流管使胆管再通被认为是缓解症状的最佳方法。生存率取决于手术范围和胆管梗阻程度。
