Department of Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara-shi, Tochigi, Japan.
Surg Today. 2012 Dec;42(12):1248-52. doi: 10.1007/s00595-012-0340-4. Epub 2012 Sep 29.
There are extremely few reports of metastases from a lower cholangiocarcinoma to the skin except for metastatic seeding in a percutaneous transhepatic biliary drainage catheter tract. This report presents a rare case of metastases to the skin after the removal of a drain following curative pancreaticoduodenectomy for lower bile duct cancer (LBDC). A 73-year-old female had undergone subtotal stomach-preserving pancreaticoduodenectomy. Skin metastasis was noted at the site where the drain from the lower border at pancreaticojejunostomy had been removed 22 weeks postoperatively, and it was en bloc resected with the abdominal wall without exposing the carcinoma. Multiple nodules were confirmed in the axilla and chest wall 40 weeks after the initial operation. Careful discussion is necessary to avoid this mode of metastasis. The surgical field should not be exposed to pancreatic juice, even with LBDC. Nevertheless, this case is rare. Therefore, the risks and benefits of using such drains must be considered.
除经皮经肝胆管引流导管途径发生转移性播种外，极少有来自下段胆管癌转移至皮肤的报道。本报告介绍了一例下段胆管癌（LBDC）行胰十二指肠切除术（PD）根治性切除术后引流管拔除后皮肤转移的罕见病例。一名 73 岁女性接受了保留胃的胰十二指肠切除术。术后 22 周，在胰肠吻合术下边界引流管取出部位发现皮肤转移，整块切除并与腹壁一起切除，未暴露癌灶。初次手术后 40 周时，在腋窝和胸壁处确认有多个结节。为避免这种转移方式，需要仔细讨论。即使是 LBDC，手术区域也不应暴露于胰液中。然而，这种情况很少见。因此，必须考虑使用此类引流管的风险和益处。
