Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan.
Hepatol Res. 2012 Feb;42(2):166-70. doi: 10.1111/j.1872-034X.2011.00908.x. Epub 2011 Dec 13.
The aim of this study was to delineate predictive factors for cholangiocarcinoma in patients with hepatolithiasis, and to establish optimal management for hepatolithiasis from the viewpoint of carcinogenesis on the basis of a Japanese nationwide survey for hepatolithiasis.
The Hepatolithiasis Research Group was organized in 2006 by the Ministry of Health, Labour and Welfare of Japan, and conducted a nationwide survey. The research group collected data on 336 cases of hepatolithiasis in 2006, in a cross-sectional survey involving 2592 institutions in Japan. Predictive factors for cholangiocarcinoma associated with hepatolithiasis were analyzed by univariate and multivariate analyses of clinicopathological and therapeutic factors.
Twenty-three patients had cholangiocarcinoma. Histories of choledocoenterostomy and liver atrophy were found to be significantly predictive factors by multivariate analysis. In 87.5% of cases of cholangiocarcinoma with liver atrophy, cholangiocarcinoma was located in the atrophic lobes. The method of reconstruction did not affect the incidence of cholangiocarcinoma (choledochojejunostomy vs. choledochoduodenostomy; side-to-end vs. side-to-side anastomosis).
Choledocoenterostomy and liver atrophy may increase the risk of developing cholangiocarcinoma. Choledocoenterostomy is thus contraindicated in patients with hepatolithiasis. An aggressive resection strategy is recommended for an atrophic segment.
本研究旨在描述肝胆管结石患者发生胆管癌的预测因素，并基于日本全国肝胆管结石调查，从癌变角度出发为肝胆管结石制定最佳治疗方案。
日本厚生劳动省于 2006 年成立了肝胆管结石研究组，并开展了一项全国性调查。该研究组通过横断面调查，在日本的 2592 家机构中收集了 2006 年 336 例肝胆管结石患者的数据。通过对临床病理和治疗因素的单因素和多因素分析，研究肝胆管结石相关胆管癌的预测因素。
23 例患者患有胆管癌。多因素分析显示，胆肠吻合术和肝萎缩史是显著的预测因素。在 87.5%的肝萎缩相关胆管癌病例中，胆管癌位于萎缩的肝叶中。重建方法不影响胆管癌的发生率（胆肠吻合术与胆肠吻合术；端侧吻合与侧侧吻合）。
胆肠吻合术和肝萎缩可能会增加发生胆管癌的风险。因此，肝胆管结石患者应避免胆肠吻合术。对于萎缩段，建议采取积极的切除策略。
