Yamada Shinichiro, Shimada Mitsuo, Utsunomiya Tohru, Morine Yuji, Imura Satoru, Ikemoto Tetsuya, Mori Hiroki, Kanamoto Mami, Hanaoka Jun, Iwahashi Shuichi, Saito Yu, Ishibashi Hiroki
The Department of Surgery, the University of Tokushima, Tokushima, Japan.
J Med Invest. 2013;60(1-2):169-73. doi: 10.2152/jmi.60.169.
Pancreaticobiliary maljunction (PBM) is associated with the occurrence of biliary cancer due to pancreatobiliary reflux. From the perspective of carcinogenesis, the treatment for PBM is controversial. We herein report a case of hilar cholangiocarcinoma 20 years after the occurrence of gallbladder cancer. A 75-year-old man was referred to our hospital regarding an obstructive jaundice and bile duct tumor. A cholecystectomy was performed for cholelithiasis on this patient 20 years ago, and cancer in situ was detected. Computed tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP) revealed a tumor of the portal hepatic region and PBM without dilatation of the bile duct. Adenocarcinoma was detected from bile cytology, and we diagnosed hilar cholangiocarcinoma. Despite the biliary decompression, jaundice was prolonged and the patient passed away. Our case suggests that not only cholecystectomy but also biliary diversion is needed for PBM regardless of the existence of bile duct dilatation.
胰胆管合流异常（PBM）因胰胆管反流与胆管癌的发生有关。从致癌角度来看，PBM的治疗存在争议。我们在此报告一例胆囊癌发生20年后出现肝门部胆管癌的病例。一名75岁男性因梗阻性黄疸和胆管肿瘤被转诊至我院。该患者20年前因胆结石接受了胆囊切除术，术中发现原位癌。计算机断层扫描（CT）和内镜逆行胰胆管造影（ERCP）显示肝门区有肿瘤且存在PBM，但胆管未扩张。胆汁细胞学检查发现腺癌，我们诊断为肝门部胆管癌。尽管进行了胆道减压，但黄疸持续时间延长，患者最终死亡。我们的病例表明，无论胆管是否扩张，PBM不仅需要行胆囊切除术，还需要进行胆道改道。
