Peel A L, Dillon E, Dellipiani A W
Br J Surg. 1981 Jul;68(7):459-62. doi: 10.1002/bjs.1800680706.
Between 1 April 1977 and 30 November 1979, 16 cases of high bile duct carcinoma presented at North Tees District Hospital, giving an incidence of one per 40000 population per annum for Teesside. Results of this prospective study emphasize the potential accuracy of preoperative assessment using techniques which should be available in a district general hospital. Ultrasound revealed the site of obstruction in every patient in whom it was used (n = 13), and often indicated a neoplastic aetiology (n = 10). Percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiography (ERC) correctly demonstrated the site of obstruction in each patient and suggested a primary bile duct carcinoma in 12 patients. Although intraoperative cholangiography gave additional information in some patients, it was not sufficiently reliable to dispense with either PTC or ERC. Histological proof of a primary bile duct carcinoma was obtained in 15 patients. In the 10 patients without obvious metastatic disease frozen section analysis was positive in 7, but was negative in 3 patients with multiple strictures where malignant cells were relatively infrequent and were found in the perineural lymphatics on paraffin sections. In this difficult group of patients the approach described eliminates the possibility of a false negative laparotomy, enables careful planning of the necessary surgical technique and also the consideration of nonoperative management.
在1977年4月1日至1979年11月30日期间，北蒂赛德区医院收治了16例高位胆管癌患者，蒂赛德地区的年发病率为每40000人中有1例。这项前瞻性研究的结果强调了使用地区综合医院应具备的技术进行术前评估的潜在准确性。超声检查在每例接受检查的患者（n = 13）中均显示出梗阻部位，且常提示肿瘤病因（n = 10）。经皮肝穿刺胆管造影（PTC）和内镜逆行胆管造影（ERC）均正确显示了每例患者的梗阻部位，并在12例患者中提示为原发性胆管癌。尽管术中胆管造影在部分患者中提供了额外信息，但它的可靠性不足以取代PTC或ERC。15例患者获得了原发性胆管癌的组织学证据。在10例无明显转移疾病的患者中，冰冻切片分析7例为阳性，但在3例有多处狭窄的患者中为阴性，这些患者的恶性细胞相对较少，在石蜡切片的神经周围淋巴管中发现。在这组困难的患者中，所描述的方法消除了剖腹探查假阴性的可能性，能够仔细规划必要的手术技术，并考虑非手术治疗。
