Kurosaki I, Tsukada K, Hatakeyama K, Muto T
First Department of Surgery, Niigata University School of Medicine, Japan.
Am J Surg. 1996 Sep;172(3):239-43. doi: 10.1016/S0002-9610(96)00156-0.
Knowing the prevalence of lymph node involvement associated with the location of the primary tumor is a prerequisite for operating with curative intent in carcinoma of the bile duct.
We evaluated 80 patients with carcinoma of the bile duct or cystic duct to investigate the frequency of lymph node involvement, the mode of lymphatic spread, and prognosis, according to the location of the primary tumor.
The frequency of lymphatic spread of carcinomas in the proximal, middle, and distal bile ducts, excluding seven T1 tumors, was 48%, 67%, and 56%, respectively. With regard to the mode of lymphatic spread: (1) a metastatic pathway along the common hepatic artery predominated over that to the retropancreatic area in the proximal duct carcinoma group; (2) in the middle duct carcinoma group, metastatic lymph nodes were distributed widely, involving nodes around the superior mesenteric artery or at the para-aortic area; and (3) in the distal duct carcinoma group, metastatic nodes generally were localized around the head of the pancreas.
Understanding the mode of the lymphatic spread according to the primary tumor may be helpful for choosing the appropriate surgical approach with curative intent in bile duct carcinoma.
了解与原发性肿瘤位置相关的淋巴结受累情况是胆管癌进行根治性手术的前提条件。
我们评估了80例胆管或胆囊管癌患者，根据原发性肿瘤的位置调查淋巴结受累频率、淋巴扩散方式及预后情况。
排除7例T1期肿瘤后，近端、中端和远端胆管癌的淋巴扩散频率分别为48%、67%和56%。关于淋巴扩散方式：（1）在近端胆管癌组中，沿肝总动脉的转移途径比向胰后区域的转移途径更常见；（2）在中端胆管癌组中，转移淋巴结分布广泛，累及肠系膜上动脉周围或主动脉旁区域的淋巴结；（3）在远端胆管癌组中，转移淋巴结通常位于胰头周围。
了解根据原发性肿瘤的淋巴扩散方式可能有助于在胆管癌中选择合适的根治性手术方式。
