Davies W, Chow M, Nagorney D
Division of Gastroenterologic and General Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Ann Surg. 1995 Nov;222(5):619-25. doi: 10.1097/00000658-199511000-00003.
The aim of this investigation was to describe the clinical features, diagnosis, pathologic characteristics, and optimal surgical management for patients with extrahepatic biliary cystadenomas.
Extrahepatic biliary cystadenomas are rare epithelial neoplasms. The clinical features and optimal surgical management for these lesions have not been defined clearly. The usual presenting symptom is jaundice. These lesions should be considered premalignant and necessitate resection. Sporadic case studies have reported instances of recurrence with local excision. To the authors' knowledge, this study represents the largest collected single series of extrahepatic biliary cystadenomas and reviews previously reported cases.
The authors reviewed and reported their institutional experience from 1950 to 1993 in treating seven patients with extrahepatic biliary cystadenomas as well as 19 previously reported cases in the literature.
A strong female predominance (96.3% of patients reviewed) was associated with extrahepatic biliary cystadenomas. Obstructive jaundice was the most common presenting symptom (85%). Abdominal pain occurred in 50% of patients; other symptoms included fever and hemobilia. The most common site of occurrence was the common hepatic duct (32%). Papillary cystadenoma with foci of invasive adenocarcinoma, thus supporting the malignant potential of cystadenomas, occurred in one patient. Local excision from the wall of the bile duct was performed in 18 patients and was associated with 50% recurrence within a mean follow-up of 13 months (range, 4-24 months). No recurrence was reported after formal sleeve resection and bilioenteric reconstruction.
Extrahepatic biliary cystadenomas can become malignant, and in this study, local surgical excision was associated with a 50% local recurrence rate. Sleeve resection with negative histologic resection margins followed by bilioenteric reconstruction, therefore, is recommended.
本研究旨在描述肝外胆管囊腺瘤患者的临床特征、诊断、病理特点及最佳手术治疗方法。
肝外胆管囊腺瘤是一种罕见的上皮性肿瘤。这些病变的临床特征和最佳手术治疗方法尚未明确界定。常见的症状是黄疸。这些病变应被视为癌前病变，需要进行切除。零星的病例研究报告了局部切除后复发的情况。据作者所知，本研究是收集的最大一组肝外胆管囊腺瘤病例系列，并对先前报道的病例进行了回顾。
作者回顾并报告了他们所在机构在1950年至1993年间治疗7例肝外胆管囊腺瘤患者的经验，以及文献中先前报道的19例病例。
肝外胆管囊腺瘤患者以女性为主（占所回顾患者的96.3%）。梗阻性黄疸是最常见的症状（85%）。50%的患者出现腹痛；其他症状包括发热和胆道出血。最常见的发病部位是肝总管（32%）。1例患者发生了伴有浸润性腺癌灶的乳头状囊腺瘤，从而支持了囊腺瘤的恶性潜能。18例患者进行了胆管壁局部切除，平均随访13个月（4 - 24个月）内复发率为50%。行正规的袖状切除及胆肠重建术后未见复发报告。
肝外胆管囊腺瘤可发生恶变，在本研究中，局部手术切除的局部复发率为50%。因此，建议行组织学切除边缘阴性的袖状切除，随后进行胆肠重建。
