Miyazaki Masaru, Takada Tadahiro, Miyakawa Shuichi, Tsukada Kazuhiro, Nagino Masato, Kondo Satoshi, Furuse Junji, Saito Hiroya, Tsuyuguchi Toshio, Chijiiwa Kazuo, Kimura Fumio, Yoshitomi Hideyuki, Nozawa Satoshi, Yoshida Masahiro, Wada Keita, Amano Hodaka, Miura Fumihiko
Department of General Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
J Hepatobiliary Pancreat Surg. 2008;15(1):15-24. doi: 10.1007/s00534-007-1276-8. Epub 2008 Feb 16.
Curative resection is the only treatment for biliary tract cancer that achieves long-term survival. However, patients with advanced biliary tract cancer have only a limited prognosis even after radical surgical resection. Thus, to improve the longterm results, the early detection of biliary tract cancer and subsequent cure seem to be essential. The purpose of this study was to review the literature concerning the risk factors for cancerous and precancerous lesions of the biliary tract, and prophylactic surgery for these factors. It has been reported that pancreaticobiliary maljunction (PBM) with bile duct dilatation is a risk factor for gallbladder cancer and bile duct cancer, while PBM without bile duct dilatation is a risk factor for gallbladder cancer. Thus, in the former group, a prophylactic excision of the common bile duct and gallbladder should be recommended, while in the later group, a prophylactic cholecystectomy without bile duct resection may be the appropriate surgical procedure. It has also been reported that primary sclerosing cholangitis (PSC) is a risk factor for cholangiocarcinoma. Patients with PSC often develop advanced cholangiocarcinoma with a poor prognosis. In patients with PSC, therefore, strict follow-up should be recommended. Adenoma and dysplasia have been regarded as precancerous lesions of gallbladder cancer. A polypoid lesion of the gallbladder that is sessile, has a diameter greater than 10 mm, and /or grows rapidly, is highly likely to be cancerous and should be resected. Although gallstones seem to be closely associated with gallbladder cancer, there is no evidence of a direct causal relationship between gallstones and gallbladder cancer. Thus, a cholecystectomy is not advised for asymptomatic cholecystolithiasis. Controversy remains as to whether adenomyomatosis of the gallbladder and porcelain gallbladder are associated with gallbladder cancer. With respect to ampullary carcinoma, adenoma of the ampulla is considered to be a precancerous lesion. This article discusses the risk factors for cancerous and precancerous lesions of the biliary tract and prophylactic treatment for these factors.
根治性切除术是实现胆管癌长期生存的唯一治疗方法。然而，晚期胆管癌患者即使接受根治性手术切除，预后也很有限。因此，为了改善长期治疗效果，早期发现胆管癌并随后治愈似乎至关重要。本研究的目的是回顾有关胆管癌癌前病变和癌性病变的危险因素以及针对这些因素的预防性手术的文献。据报道，伴有胆管扩张的胰胆管合流异常（PBM）是胆囊癌和胆管癌的危险因素，而不伴有胆管扩张的PBM是胆囊癌的危险因素。因此，对于前一组患者，建议预防性切除胆总管和胆囊，而对于后一组患者，不进行胆管切除的预防性胆囊切除术可能是合适的手术方式。也有报道称原发性硬化性胆管炎（PSC）是胆管癌的危险因素。PSC患者常发展为预后不良的晚期胆管癌。因此，对于PSC患者，建议进行严格的随访。腺瘤和发育异常被认为是胆囊癌的癌前病变。胆囊的息肉样病变如果是无蒂的、直径大于10毫米和/或生长迅速，则极有可能是癌性的，应予以切除。虽然胆结石似乎与胆囊癌密切相关，但没有证据表明胆结石与胆囊癌之间存在直接因果关系。因此，不建议对无症状胆囊结石患者进行胆囊切除术。关于胆囊腺肌增生症和瓷化胆囊是否与胆囊癌有关仍存在争议。关于壶腹癌，壶腹腺瘤被认为是癌前病变。本文讨论了胆管癌癌前病变和癌性病变的危险因素以及针对这些因素的预防性治疗。
