Engels J T, Balfe D M, Lee J K
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO 63110.
Radiology. 1989 Jul;172(1):35-40. doi: 10.1148/radiology.172.1.2544924.
The authors studied the computed tomographic (CT) images obtained in 56 patients with pathologically proved biliary cancer and 75 patients with no evidence of biliary disease, attempting to define the normal anatomy of the lymphatic system draining the bile ducts and the prevalence of extrahepatic spread of primary biliary cancer into these retroperitoneal planes. Of 20 patients with gallbladder cancer, 14 (70%) had proved adenopathy and nine (45%) had peritoneal spread at presentation, and another three later developed carcinomatosis. Of 22 patients with proximal cholangiocarcinoma, 16 (73%) had nodal involvement at presentation, four later developed adenopathy, and five had peritoneal dissemination. Distal or diffuse cholangiocarcinomas were less associated with metastatic nodes or peritoneal spread. For all biliary cancers, the nodes most commonly involved were the node of the foramen of Winslow, the superior pancreatoduodenal node, and the posterior pancreatoduodenal chain. Extrahepatic tumor spread produced proximal intestinal obstruction in 13 patients (23%). CT reliably demonstrates lymphatic or other extrahepatic spread of biliary cancers, which may have an important bearing on management decisions.
作者研究了56例经病理证实患有胆管癌的患者以及75例无胆管疾病证据的患者的计算机断层扫描（CT）图像，试图明确引流胆管的淋巴系统的正常解剖结构以及原发性胆管癌肝外扩散至这些腹膜后平面的发生率。20例胆囊癌患者中，14例（70%）在就诊时已证实有淋巴结病，9例（45%）有腹膜扩散，另有3例后来发展为癌性腹膜炎。22例肝门部胆管癌患者中，16例（73%）在就诊时已有淋巴结受累，4例后来出现淋巴结病，5例有腹膜播散。远端或弥漫性胆管癌与转移性淋巴结或腹膜扩散的相关性较小。对于所有胆管癌，最常受累的淋巴结是网膜孔淋巴结、胰十二指肠上淋巴结和胰十二指肠后链。肝外肿瘤扩散导致13例患者（23%）出现近端肠梗阻。CT能可靠地显示胆管癌的淋巴或其他肝外扩散情况，这可能对治疗决策有重要影响。
