Colovic Radoje B, Grubor Nikica M, Jovanovic Miodrag D, Micev Marjan T, Colovic Natasa R
Institute for Digestive Diseases, First Surgical Clinic, Clinical Center of Serbia, Koste Todorovica 6, Belgrade 11000, Serbia.
World J Gastroenterol. 2007 Feb 7;13(5):813-5. doi: 10.3748/wjg.v13.i5.813.
Metastatic melanoma to the common bile duct is very rare with only 18 cases reported so far. We report a 46 year old women who, 18 mo after excision of a skin melanoma, developed a painless progressive obstructive jaundice. At operation a melanoma within the distal third of the common bile duct was found. There were no other secondaries within the abdomen. The common bile duct, including the tumor, was resected and anastomosed with Roux-en-Y jejunal limb. The patient survived 31 mo without any sign of local recurrence and was submitted to three other operations for axillar and brain secondaries, from which she finally died. Radical resection of metastatic melanoma to the common bile duct may result in lifelong relief of obstructive jaundice. It is safe and relatively easy to perform. In other cases, a less aggressive approach, stenting or bypass procedures, should be adopted.
黑色素瘤转移至胆总管极为罕见,迄今为止仅有18例报道。我们报告一名46岁女性,在皮肤黑色素瘤切除术后18个月,出现无痛性进行性梗阻性黄疸。手术时发现胆总管远侧三分之一段有一黑色素瘤。腹内无其他继发性肿瘤。切除包括肿瘤在内的胆总管,并与空肠袢行Roux-en-Y吻合术。患者存活31个月,无局部复发迹象,因腋窝和脑部继发性肿瘤又接受了三次手术,最终死亡。对转移至胆总管的黑色素瘤进行根治性切除可使梗阻性黄疸得到永久性缓解。该手术安全且操作相对简单。在其他情况下,应采用较保守的方法,如支架置入或旁路手术。