Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
Ann Surg Oncol. 2024 Feb;31(2):1264-1267. doi: 10.1245/s10434-023-14500-5. Epub 2023 Oct 31.
Surgical resection remains the sole approach to achieving long-term survival in cholangiocarcinoma cases. The universally recognised standard procedures for such cases include pancreaticoduodenectomy (PD) or hemihepatectomy accompanied by bile duct reconstruction. Nevertheless, some patients may still attain curative intent through bile duct segmental resection (BDR). However, these procedures are still in the experimental stage and should only be recommended for carefully chosen patients.
A 57-year-old male patient was admitted to our department after two weeks of escalating jaundice and abdominal discomfort. Upon admission, his total bilirubin was recorded at 102 μmol/L, and his direct bilirubin was 87 μmol/L. His carbohydrate antigen 19-9 (CA 19-9), carcinoembryonic antigen (CEA) and alpha fetoprotein (AFP) levels were normal. Enhanced computed tomography (CT) and magnetic resonance imaging (MRI) scans revealed a thickened and enhanced biliary tree extending from the cystic duct junction to the common hepatic duct no vascular invasion indicated by three-dimensional reconstruction.
The patient underwent laparoscopic resection of the extrahepatic bile duct, accompanied by radical lymphadenectomy with skeletonisation and biliary reconstruction, was successfully conducted within 320 min, with a minimal blood loss of only 50 ml. The histological grading of the procedure was T2bN0M0 (stage II). The patient was discharged on the sixth postoperative day without complications. Following this, he underwent a regimen of single-agent capecitabine chemotherapy. After an 18-month follow-up period, no recurrence was observed.
Our experience suggests that in selected patients diagnosed with middle bile duct cholangiocarcinoma, laparoscopic resection could potentially reach the standard of lymphadenectomy through skeletonisation.
手术切除仍然是胆管癌患者实现长期生存的唯一方法。此类病例公认的标准手术包括胰十二指肠切除术（PD）或半肝切除术伴胆管重建。然而，一些患者仍可通过胆管节段切除术（BDR）达到治愈目的。然而，这些手术仍处于实验阶段，仅应推荐给精心挑选的患者。
一名 57 岁男性患者因两周来黄疸和腹部不适逐渐加重而入院。入院时，总胆红素为 102μmol/L，直接胆红素为 87μmol/L。其糖类抗原 19-9（CA 19-9）、癌胚抗原（CEA）和甲胎蛋白（AFP）水平正常。增强计算机断层扫描（CT）和磁共振成像（MRI）扫描显示，从胆囊管汇合处到肝总管的胆管树增厚并增强，三维重建未显示血管侵犯。
患者成功接受了腹腔镜下肝外胆管切除术，同时进行了根治性淋巴结清扫伴骨骼化和胆管重建，手术耗时 320 分钟，出血量仅 50ml。手术的组织学分级为 T2bN0M0（II 期）。患者术后第六天无并发症出院。随后，他接受了单药卡培他滨化疗。经过 18 个月的随访，未观察到复发。
我们的经验表明，在选定的中胆管胆管癌患者中，腹腔镜切除术通过骨骼化可能达到淋巴结清扫的标准。
