Tsou Yung-Kuan, Liu Nai-Jen, Wu Ren-Chin, Lee Ching-Song, Tang Jui-Hsiang, Hung Chien-Fu, Jan Yi-Yin
Departments of Hepato-Gastroenterology, Pathology, Chang Gung Memorial Hospital & Chang Gung University College of Medicine, Taipei, Taiwan.
Scand J Gastroenterol. 2008;43(9):1137-44. doi: 10.1080/00365520802029856.
Some biliary neoplasms secrete copious mucin into bile ducts, yet the management of mucobilia is not well known. The objective of this study was to analyze 16 patients with copious mucin in the biliary tract stressing the diagnostic and therapeutic aspects of endoscopic retrograde cholangiography (ERC).
Sixteen patients with mucobilia were found among 5635 cases of ERC from October 1999 to October 2006 in our institution. Diagnostic and therapeutic ERC as well as clinical features were retrospectively analyzed.
Mucin had a greater impact than the neoplasm itself on the cholangiogram and clinical presentation. ERC failed to show the tumors but a disproportionate or aneurysmal dilatation of the segmental or lobar duct correlated with the tumor-bearing duct was evident. Endoscopic managements included clearance of intraductal mucin and/or endoscopic nasobiliary drainage (ENBD). Three patients were excluded from outcome assessment because of non-specific symptoms or spontaneously subsiding jaundice. Among the 13 patients eligible for assessment, subjective improvement in symptoms and/or a decrease in jaundice along with subsiding cholangitis following ERC was observed in 5 of the 7 patients that underwent both clearance of intraductal mucin and ENBD (ENBD function was poor in all 7 patients), in 1 patient who underwent only clearance of intraductal mucin, and in 3 of the 5 patients who underwent only ENBD. The three patients with progressive jaundice, despite endoscopic management, had advanced disease.
ERC revealed the tumor-bearing duct but not the extent of the disease in most of the patients with mucobilia. When mucobilia is encountered during ERC, the management should include clearance of as much intraductal mucin as possible. ENBD is frequently obstructed by mucin and may be helpful only in selected cases.
一些胆道肿瘤会向胆管内大量分泌黏液，但黏液性胆汁的处理方法尚不为人熟知。本研究的目的是分析16例胆道内有大量黏液的患者，重点关注内镜逆行胆管造影术（ERC）的诊断和治疗方面。
1999年10月至2006年10月期间，在本机构进行的5635例ERC病例中发现了16例黏液性胆汁患者。对诊断性和治疗性ERC以及临床特征进行回顾性分析。
黏液对胆管造影和临床表现的影响比肿瘤本身更大。ERC未能显示肿瘤，但与肿瘤所在胆管相关的节段性或叶性胆管不成比例的扩张或动脉瘤样扩张很明显。内镜治疗包括清除导管内黏液和/或内镜鼻胆管引流（ENBD）。3例患者因症状不典型或黄疸自行消退而被排除在疗效评估之外。在13例符合评估条件的患者中，7例同时接受了导管内黏液清除和ENBD（所有7例患者的ENBD功能均较差），其中5例在ERC后症状主观改善和/或黄疸减轻，胆管炎消退；1例仅接受了导管内黏液清除，5例仅接受了ENBD，其中3例出现这种情况。3例黄疸进行性加重的患者，尽管接受了内镜治疗，但病情已进展。
在大多数黏液性胆汁患者中，ERC显示了肿瘤所在的胆管，但未显示疾病的范围。当在ERC过程中遇到黏液性胆汁时，处理应包括尽可能清除导管内的黏液。ENBD常被黏液阻塞，可能仅在特定病例中有用。
