Okumura Yuichiro, Asaoka Tadafumi, Eguchi Hidetoshi, Iwagami Yoshifumi, Yamada Daisaku, Noda Takehiro, Wada Hiroshi, Kawamoto Koichi, Goto Kunihito, Mori Masaki, Doki Yuichiro
Dept. of Gastroenterological Surgery, Graduate School of Medicine, Osaka University.
Gan To Kagaku Ryoho. 2016 Nov;43(12):2095-2097.
A 41-year-old woman had undergone cyst-to-duct anastomosis for a congenital biliary dilatation when she was 3-yearold. After 38 years, she presented with a high fever, and laboratory findings showed elevation of liver and biliary enzyme levels. A CT scan showed a mass lesion in a choledochal cyst, and an adenocarcinoma was found in the anastomosis of the choledochal cyst and duodenum. We diagnosed distal bile duct cancer and performed SSPPD after neoadjuvant chemotherapy( gemcitabine plus cisplatin plus S-1). The resected tumor was pathologically diagnosed as papillary-infiltrating adenocarcinoma( ypT2N1M0, ypStage II B). Currently, 9 months after the second surgery, the patient is doing well without any signs of recurrence. The current case suggested the necessity of postoperative lifetime follow-up for patients with bile duct cancer who have undergone radical cyst excision for a congenital biliary dilatation.
一名41岁女性在3岁时因先天性胆管扩张接受了囊肿-胆管吻合术。38年后，她出现高热，实验室检查结果显示肝酶和胆酶水平升高。CT扫描显示胆总管囊肿内有一个肿块病变，在胆总管囊肿与十二指肠的吻合处发现了腺癌。我们诊断为远端胆管癌，并在新辅助化疗（吉西他滨加顺铂加S-1）后进行了胰头十二指肠切除术。切除的肿瘤经病理诊断为乳头浸润性腺癌（ypT2N1M0，ypII B期）。目前，第二次手术后9个月，患者情况良好，没有任何复发迹象。本例提示，对于因先天性胆管扩张接受根治性囊肿切除的胆管癌患者，术后需要终身随访。
