Centre HépatoBiliaire, Paul Brousse Hospital, Assistance Publique Hôpitaux de Paris, University of Paris XI, 94, Villejuif, France.
J Hepatobiliary Pancreat Sci. 2010 May;17(3):241-5. doi: 10.1007/s00534-009-0151-1. Epub 2009 Aug 1.
Surgical resection, considered the optimal treatment of biliary papillomatosis, often remains incomplete due to high risk of recurrence in view of positive margins or recurrence on the remnant bile duct because of its multifocality. Resection of the whole biliary tree by liver transplantation and duodenopancreatectomy can be regarded as the only curative treatment. However, this approach has resulted in unfavorable results in patients with advanced tumor invasion and/or positive lymph nodes. For the majority of biliary tumors, preoperative assessment is often insufficient. Therefore, we advocate initial partial resection as a first step to eliminate both advanced tumor invasion and/or positive lymph nodes on definitive analysis of the specimen. We propose the strategy of initial resection for selecting the patients who would actually benefit from liver transplantation.
手术切除被认为是治疗胆管乳头状瘤的最佳方法，但由于存在阳性切缘或残留胆管复发的高风险，因此往往无法完全切除，因为其具有多灶性。通过肝移植和胰十二指肠切除术切除整个胆管树可被视为唯一的治愈性治疗方法。然而，对于肿瘤侵袭程度较高和/或淋巴结阳性的患者，这种方法的结果并不理想。对于大多数胆道肿瘤，术前评估往往不足。因此，我们主张最初进行部分切除作为第一步，以消除在对标本进行明确分析时存在的晚期肿瘤侵袭和/或阳性淋巴结。我们提出了初始切除的策略，以选择那些实际上受益于肝移植的患者。
