Sugiyama M, Atomi Y, Kuroda A, Muto T
First Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan.
Hepatogastroenterology. 1997 Sep-Oct;44(17):1477-83.
BACKGROUND/AIMS: Most bile duct carcinomas are diagnosed at an advanced stage, after the appearance of jaundice. The features of bile duct carcinomas without jaundice were analyzed with the aim of allowing early diagnosis in such cases.
Clinicopathological features, images and surgical outcomes were compared between 18 non-jaundiced and 85 jaundiced patients with extrahepatic bile duct carcinoma.
Among the non-jaundiced patients, 13 were symptomatic. Abnormalities on hepatic function and tumor marker tests were seen in 56% and 44%, respectively. In all 18 cases, ultrasonography demonstrated biliary abnormalities including masses (9 patients) and strictures (5 patients). The diagnosis was confirmed histologically by transpapillary bile duct biopsy in eight of 10 non-jaundiced patients. The non-jaundiced patients (83%) had a higher rate of resectability than jaundiced patients (58%). Pathological findings of resected specimens showed no significant differences between the two groups. The non-jaundiced group had a significantly higher survival rate than the jaundiced group: 50% vs. 22% at 5 years.
For early diagnosis of bile duct carcinomas not associated with jaundice, detailed ultrasonographic examination is useful, and subtle changes indicate a need for direct cholangiography. Non-jaundiced cases have the potential for curative resection.
背景/目的：大多数胆管癌在黄疸出现后被诊断为晚期。分析无黄疸胆管癌的特征，以便在此类病例中实现早期诊断。
比较18例无黄疸和85例有黄疸的肝外胆管癌患者的临床病理特征、影像学表现及手术结果。
在无黄疸患者中，13例有症状。肝功能和肿瘤标志物检查异常分别见于56%和44%的患者。所有18例患者的超声检查均显示胆道异常，包括肿块（9例）和狭窄（5例）。10例无黄疸患者中有8例经经乳头胆管活检组织学确诊。无黄疸患者的可切除率（83%）高于黄疸患者（58%）。切除标本的病理结果显示两组之间无显著差异。无黄疸组的生存率显著高于黄疸组：5年生存率分别为50%和22%。
对于未伴有黄疸的胆管癌的早期诊断，详细的超声检查很有用，细微变化提示需要直接胆管造影。无黄疸病例有根治性切除的可能。
