La Greca G, Puleo S, Li Destri G, Di Carlo I, Lombardo R, Rodolico M, Di Cataldo A, Licata A
Policlinico- Istituto di I Clinica Chirurgica, Università degli Studi, Catania.
Minerva Chir. 1997 Jan-Feb;52(1-2):33-8.
Cancer of the extrahepatic biliary tract is a rare disease related to a severe prognosis. The resection of the extrahepatic biliary tract is a complex procedure and the preoperative assessment of resectability is made difficult because of the malignancies. Biliary cancer resection can be curative in some patients but in some cases a liver resection has also to be performed. The authors retrospectively analyzed their recent cases closely examining some anatomical and technical aspects of biliary cancer resection. Eight patients were treated, three had distal cancer, two a central and three a proximal one (Klatskin tumor). In seven patients (87%) the cancer had spread to the liver. In one patient there was a favourable anatomical variation. All eight patients underwent laparotomy and in two (25%) the biliary cancer could be resected but curatively only in one case. Six patients underwent palliative procedures with a maximal survival of 8 months. The only curatively resected patient is well, without recurrence, 13 months after surgery. These results are similar to those reported concerning resectability and survival but a higher rate of liver metastases strongly reduced the amount of possibly curative resections. The experience shows the importance of laparotomy and of the knowledge of anatomy for a correct approach to resection and palliation of this cancer.
肝外胆管癌是一种预后较差的罕见疾病。肝外胆管切除术是一个复杂的手术，由于恶性肿瘤的存在，术前可切除性评估变得困难。胆管癌切除术在一些患者中可能治愈，但在某些情况下还需要进行肝切除术。作者回顾性分析了他们最近的病例，仔细研究了胆管癌切除术的一些解剖学和技术方面。共治疗了8例患者，3例为远端癌，2例为中段癌，3例为近端癌（肝门部胆管癌）。7例患者（87%）的癌症已扩散至肝脏。1例患者存在有利的解剖变异。所有8例患者均接受了剖腹手术，2例（25%）患者的胆管癌得以切除，但仅1例实现了根治性切除。6例患者接受了姑息性手术，最长生存期为8个月。唯一根治性切除的患者术后13个月情况良好，无复发。这些结果与有关可切除性和生存率的报道相似，但较高的肝转移率极大地减少了可能的根治性切除数量。该经验表明剖腹手术以及了解解剖学对于正确处理这种癌症的切除和姑息治疗的重要性。
