Sano T, Yamamoto J, Kosuge T, Inoue K, Shimada K, Takayama T, Yamazaki S, Sakamoto M, Hirohashi S
Department of Surgery, National Cancer Center Hospital, Tokyo, Japan.
Hepatogastroenterology. 1996 May-Jun;43(9):667-70.
A case of intrahepatic cholangiocarcinoma with intrabile duct tumor growth is presented. A 70-year-old female with prolonged obstructive jaundice and cholangitis was diagnosed with a mass lesion in the left lobe of the liver accompanied by an intrabile duct component which caused hilar bile duct obstruction. Percutaneous transhepatic biliary drainage (PTBD) was performed via three routes with intensive care of the drainage catheters over a 2-month period to alleviate jaundice and cholangitis. Extended left hepatic lobectomy with combined resection of extrahepatic bile duct and regional lymph nodes were carried out curatively. Macroscopically, a tumor formed a 8 x 6 cm mass with a scalloped margin in the left lobe and had an intraductal component with a round smooth surface protruding from the lumen of the left hepatic duct into the common bile duct. The histologic type of the tumor was well differentiated tubular adenocarcinoma. The intraluminal tumor grew expansively without invasion to the bile duct wall. The postoperative course was uneventful and the patient has remained in good health without recurrence for 1 year and 3 months since surgery. This case report discusses a rare extension pattern in ICC and the management of malignant hilar obstruction during radical surgery.
本文报告一例肝内胆管癌伴胆管内肿瘤生长的病例。一名70岁女性，患有长期梗阻性黄疸和胆管炎，被诊断为肝左叶有一肿块病变，伴有胆管内成分，导致肝门部胆管梗阻。通过三条途径进行经皮经肝胆道引流（PTBD），并在2个月内对引流导管进行精心护理，以减轻黄疸和胆管炎。进行了扩大左肝叶切除术，并联合切除肝外胆管和区域淋巴结，达到了根治效果。大体上，肿瘤在左叶形成一个8×6 cm大小、边缘呈扇贝状的肿块，并有一个导管内成分，其表面圆形光滑，从左肝管腔突出至胆总管。肿瘤的组织学类型为高分化管状腺癌。管腔内肿瘤呈膨胀性生长，未侵犯胆管壁。术后过程顺利，自手术以来，患者健康状况良好，1年零3个月未复发。本病例报告讨论了肝内胆管癌一种罕见的扩展模式以及根治性手术期间恶性肝门梗阻的处理。
