Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, South Korea.
World J Surg. 2013 Feb;37(2):437-42. doi: 10.1007/s00268-012-1844-1.
Despite its wide use, catheter tract recurrence after percutaneous biliary drainage (PBD) is rarely reported. However, one recent large-scale study reported a catheter tract recurrence rate as high as 5.2 % in patients with perihilar or distal bile duct cancer. We report on our 20 years of experience with catheter tract seeding after PBD for hilar cholangiocarcinoma.
The medical records of 441 patients who underwent operation for hilar cholangiocarcinoma between 1991 and 2011 were retrospectively analyzed.
Of the 441 patients with hilar cholangiocarcinoma, PBD was performed in 315 patients, and 232 others underwent resection of hilar cholangiocarcinoma with PBD. Catheter tract recurrence developed in 6 patients (2.6 %). The median drainage duration was 30 days, and 1 patient had multiple PBDs. The median time to catheter recurrence after surgery was 10.9 months. Three patients underwent curative resection of the abdominal wall followed by chemotherapy, 1 patient underwent chemotherapy only, and 2 patients received conservative treatment. Five patients in whom the catheter tract recurrence was their first recurrence died of systemic recurrence at median 3.9 months after detection of catheter tract seeding. T1 or 2 disease (66.7 vs. 31.3 %; p = 0.086) tended to have catheter tract seeding with marginal significance. The overall survival rate was lower in patients with catheter tract seeding than in those without (median 17.5 vs. 23.0 months; p = 0.089).
The PBD catheter tract recurrence rate for hilar cholangiocarcinoma was 2.6 %. However, patients with catheter tract recurrence had a poor prognosis despite complete surgical metastasectomy.
尽管经皮胆道引流（PBD）应用广泛，但胆道引流管窦道复发的报道却很少见。然而，最近一项大规模研究报道，在肝门部或远端胆管癌患者中，胆道引流管窦道复发率高达 5.2%。我们报告了我们在经皮胆道引流治疗肝门部胆管癌 20 年的经验。
回顾性分析了 1991 年至 2011 年间接受肝门部胆管癌手术的 441 例患者的病历。
441 例肝门部胆管癌患者中，315 例行 PBD，232 例行 PBD 联合肝门部胆管癌切除术。6 例（2.6%）发生胆道引流管窦道复发。引流时间中位数为 30 天，1 例患者多次行 PBD。术后胆道引流管窦道复发中位时间为 10.9 个月。3 例行腹壁根治性切除术联合化疗，1 例行化疗，2 例行保守治疗。5 例患者因胆道引流管窦道复发而死亡，中位生存时间为检测到胆道引流管窦道种植后 3.9 个月。T1 或 T2 期疾病（66.7%比 31.3%；p=0.086）有发生胆道引流管窦道种植的趋势，但无统计学意义。有胆道引流管窦道种植的患者总生存率低于无胆道引流管窦道种植的患者（中位生存时间 17.5 个月比 23.0 个月；p=0.089）。
肝门部胆管癌经皮胆道引流管窦道复发率为 2.6%。然而，尽管行完全性外科转移灶切除术，有胆道引流管窦道种植的患者预后仍较差。
