Frameglia M, Nimura Y, Hayakawa N, Kamiya J, Kondo S, Nagino M, Kanai M, Miyachi M
First Department of Surgery, Nagoya University School of Medicine, Japan.
Hepatogastroenterology. 1996 Jul-Aug;43(10):1029-34.
We describe a case of biliary cystadenocarcinoma of the liver in a 72 year-old woman presented to our hospital with abdominal fullness. Laboratory data showed an elevation of alkaline phosphatase and a decreased excretion of Indocyanine green (ICG). CT revealed a cystic tumor with papillary projections, measuring 13A approximately 15cm, in the left medial segment of the liver (S4). Percutaneous transhepatic cholangioscopy (PTCS) disclosed the tumor in the dorsal subsegmental duct of S4 and the cholangioscopic biopsy from the tumor revealed papillary adenocarcinoma. PTCS showed the left lateral posterior segmental bile duct (B2) joined the common tract of the left medial (B4) and left lateral anterior (B3) segmental bile duct, and the tumor involved B4 and B3 but not the common tract of B4 and B3. A radical surgery, which included segment 4 and 3 resection with preservation of the left hepatic duct and the segment 2 was performed. The histopathological examination revealed that the tumor did not involve the liver parenchyma and had no lymph node metastasis. Postoperative course was unremarkable and the patient at present time, 4 years after the operation, is doing well. This case report discusses the importance of preoperative evaluation by PTCS for a rational surgical procedure.
我们报告一例72岁女性的肝内胆管囊腺癌，该患者因腹部胀满前来我院就诊。实验室检查数据显示碱性磷酸酶升高，吲哚菁绿（ICG）排泄减少。CT显示肝脏左内侧段（S4）有一个带有乳头状突起的囊性肿瘤，大小约为13×15cm。经皮经肝胆道镜检查（PTCS）发现S4背侧亚段胆管内有肿瘤，对肿瘤进行的胆道镜活检显示为乳头状腺癌。PTCS显示肝左外侧后段胆管（B2）汇入肝左内侧（B4）和肝左外侧前段（B3）胆管的共同管道，肿瘤累及B4和B3，但未累及B4和B3的共同管道。实施了根治性手术，包括切除4段和3段，保留左肝管和2段。组织病理学检查显示肿瘤未累及肝实质，无淋巴结转移。术后病程平稳，目前患者术后4年，情况良好。本病例报告讨论了PTCS术前评估对合理手术操作的重要性。
