Iyomasa S, Nimura Y, Kamiya J, Maeda S, Kondo S, Yasui A, Shionoya S
First Department of Surgery, Nagoya University School of Medicine, Japan.
Nihon Geka Gakkai Zasshi. 1991 Apr;92(4):448-52.
We reviewed 60 cases of biliary carcinoma with hilar bile duct stenosis which had received percutaneous transhepatic cholangio-drainage (PTCD). Of the 60 cases, nine were complicated with acute cholangitis (AC) and three with segmental acute obstructive suppurative cholangitis (S-AOSC). The incidence of cholangitis was 20%. Six patients with AC and three with S-AOSC underwent hepatic resection for carcinoma. As to preoperative management for cholangitis in these 9 cases, conservative chemotherapy was effective in only 2 cases, and additional PTCD or segmental introduction of the drainage catheter under PTCS were useful in 5 cases. The remaining 2 cases with S-AOSC needed urgent hepatic resection including suppurative hepatic segments after various interventional treatments. No significant difference was found in resectability, morbidity and mortality between the cholangitis group and non-cholangitis group. In conclusion, it is emphasized that postoperative outcome of biliary carcinoma with cholangitis will be improved by adequate PTCD and/or urgent hepatic resection.
我们回顾了60例伴有肝门部胆管狭窄的胆管癌患者，这些患者均接受了经皮经肝胆道引流术（PTCD）。60例患者中，9例并发急性胆管炎（AC），3例并发节段性急性梗阻性化脓性胆管炎（S-AOSC）。胆管炎的发生率为20%。6例AC患者和3例S-AOSC患者接受了肝癌肝切除术。对于这9例胆管炎患者的术前处理，保守化疗仅在2例中有效，另外5例通过额外的PTCD或在经皮经肝胆道穿刺引流术（PTCS）下节段性置入引流导管有效。其余2例S-AOSC患者在接受各种介入治疗后需要紧急肝切除，包括切除化脓性肝段。胆管炎组和非胆管炎组在可切除性、发病率和死亡率方面未发现显著差异。总之，强调通过适当的PTCD和/或紧急肝切除可改善胆管炎型胆管癌的术后结局。
