Roslyn J J, Kuchenbecker S, Longmire W P, Tompkins R K
Arch Surg. 1984 Nov;119(11):1312-5. doi: 10.1001/archsurg.1984.01390230078019.
Tumor debris, free-floating in the major biliary ductal system, is a cause of intermittent biliary obstruction that has previously not been recognized. Six patients had hepatic neoplasms with episodic jaundice and/or cholangitis due to floating tumor debris. Diagnosis included metastatic adenocarcinoma of the colon (n = 3), cholangiocarcinoma (n = 1), hepatocellular carcinoma (n = 1), and cavernous hemangioma (n = 1). All patients underwent biliary exploration, with hepatic resection and transhepatic intubation in two and T-tube placement in four. One patient died in the early postoperative period, and the major complication rate in the five survivors was 0%. Four of the five survivors had no further episodes suggestive of major bile duct obstruction. Our experience emphasizes the importance of distinguishing extrahepatic obstruction secondary to tumor debris from the more common causes of jaundice in patients with tumors and suggests that safe and effective palliation can be achieved in these patients.
游离于主要胆管系统中的肿瘤碎片是此前未被认识到的间歇性胆管梗阻的一个原因。6例患者因漂浮的肿瘤碎片出现肝脏肿瘤并伴有发作性黄疸和/或胆管炎。诊断包括结肠转移性腺癌（3例）、胆管癌（1例）、肝细胞癌（1例）和海绵状血管瘤（1例）。所有患者均接受了胆管探查，其中2例行肝切除术和经肝插管，4例行T管放置。1例患者在术后早期死亡，5例幸存者的主要并发症发生率为0%。5例幸存者中有4例未再出现提示主要胆管梗阻的发作。我们的经验强调了将肿瘤碎片继发的肝外梗阻与肿瘤患者更常见的黄疸原因相区分的重要性，并表明这些患者能够实现安全有效的姑息治疗。
