Warshaw A L, Welch J P
Ann Surg. 1978 Nov;188(5):593-7. doi: 10.1097/00000658-197811000-00002.
Extrahepatic biliary obstruction can be caused by cancer metastatic from the colon to the lymph nodes adjacent to the bile duct. This report details our experience with eight such cases treated at the Massachusetts General Hospital in the last seven years. The interval between resection of the primary tumor and appearance of jaundice averaged 13 months. The location of the obstruction, preferably defined preoperatively by cholangiography, was low on the common duct in three cases and high in the porta hepatis in five. Relief of biliary obstruction was accomplished by biliary-enteric bypass (four cases), internal biliary stenting by permanent indwelling tube (two cases), or by portal irradiation (two cases). In addition to palliating the symptoms of obstructive jaundice, the period of comfortable survival appears to have been extended: the bypassed patients lived 13-38 months. Erosion of tumor into the duodenum, with resulting gastrointestinal hemorrhage, was an additional problem in three patients. Our overall experience illustrates the value of distinguishing this subgroup of patients from the larger number whose jaundice results from extensive liver metastases, and of treating aggressively those with extrahepatic biliary obstruction.
肝外胆管梗阻可由结肠癌转移至胆管旁淋巴结所致。本报告详述了过去七年里我们在麻省总医院治疗的八例此类病例的经验。原发肿瘤切除与黄疸出现之间的间隔平均为13个月。梗阻部位最好术前通过胆管造影确定，三例位于胆总管低位，五例位于肝门高位。通过胆肠吻合术（四例）、永久性留置管进行胆管内支架置入（两例）或门静脉照射（两例）实现了胆管梗阻的缓解。除了缓解梗阻性黄疸症状外，舒适生存期似乎也有所延长：接受吻合术的患者存活了13至38个月。三例患者还出现肿瘤侵蚀十二指肠导致胃肠道出血的额外问题。我们的总体经验表明，将这一亚组患者与因广泛肝转移导致黄疸的大量患者区分开来，并积极治疗肝外胆管梗阻患者具有重要意义。
