Tanaka N, Nobori M, Suzuki Y
Department of Surgery, Asahi General Hospital, Chiba, Japan.
Surg Today. 1997;27(11):1010-4. doi: 10.1007/BF02385780.
Whether bile spillage during operation presents a risk for peritoneal metastasis in the treatment of bile duct carcinoma was studied in 15 patients (12 with bile duct cancer, 3 with cancer of the papilla of Vater) who had all undergone a pancreatoduodenectomy. Preoperative bile was sampled through a percutaneous transhepatic biliary drainage catheter. Nine patients with bile duct cancer and one with cancer of the papilla of Vater showed positive bile cytology. The operative bile was obtained at the hepatic duct stump after a resection of the tumor-bearing bile duct. The operative bile in 10 patients with positive preoperative bile was found to be positive, while that in the five patients with negative preoperative bile was negative. Thus, the specificity of operative bile was identified as 100%. Moreover, in five patients with preoperative positive bile, saline irrigation of intrahepatic bile duct after a full recovery of hepatic bile revealed cancer cells to remain in the intrahepatic biliary trees. The viability of preoperative bile was 61%-97% with 1 x 10(4)-2.4 x 10(5) tumor cells, whereas there was a 41%-97% viability with 7.6 x 10(4)-10.4 x 10(5) tumor cells in the operative or irrigated bile. Accordingly, the patients with preoperative positive bile are thus suggested to be at high risk of inducing peritoneal metastasis due to the inadvertent spillage of hepatic bile at the time of resection of a bile duct tumor.
对15例均接受过胰十二指肠切除术的患者（12例胆管癌患者，3例 Vater 乳头癌患者）进行研究，以探讨手术过程中胆汁外溢在胆管癌治疗中是否会导致腹膜转移。术前通过经皮经肝胆道引流导管采集胆汁。9例胆管癌患者和1例 Vater 乳头癌患者胆汁细胞学检查呈阳性。手术胆汁在切除含肿瘤胆管后于肝管残端获取。术前胆汁阳性的10例患者的手术胆汁被发现为阳性，而术前胆汁阴性的5例患者的手术胆汁为阴性。因此，手术胆汁的特异性被确定为100%。此外，在5例术前胆汁阳性的患者中，肝胆汁完全恢复后对肝内胆管进行生理盐水冲洗，发现癌细胞仍存在于肝内胆管树中。术前胆汁的活力为61% - 97%，肿瘤细胞数量为1×10⁴ - 2.4×10⁵个，而手术或冲洗胆汁中肿瘤细胞数量为7.6×10⁴ - 10.4×10⁵个时，活力为41% - 97%。因此，术前胆汁阳性的患者因胆管肿瘤切除时肝胆汁意外外溢而导致腹膜转移的风险较高。
