Seki H, Miyagawa S, Kobayashi A, Kawasaki S
First Department of Surgery, Shinshu University, School of Medicine, Matsumoto, Japan.
HPB Surg. 1998;10(6):395-7. doi: 10.1155/1998/93740.
The clinicopathological features and surgical treatment of biliary carcinoma around the major hepatic duct confluence arising after pancreatoduodenectomy (PD) due to initial bile duct carcinoma are described in three patients. Occurrence of biliary carcinoma more than 12 years after initial surgery and a histological finding of cholangiocellular carcinoma mixed with hepatocellular carcinoma suggested metachronous incidence of biliary carcinoma after PD. Extended right hemihepatectomy with complete removal of the residual extrahepatic bile duct and segmental resection of the jejunal loop were carried out safely without operative death or severe postoperative complications. Two patients died of tumor recurrence 6 months after surgery, and the remaining patient is currently living a normal life without evidence of recurrence 17 months after surgery. These surgical procedures are a therapeutic option in patients with biliary carcinoma around the major hepatic duct confluence arising after PD.
本文描述了3例因原发性胆管癌行胰十二指肠切除术（PD）后发生的肝门部胆管周围癌的临床病理特征及手术治疗情况。初次手术后12年以上发生胆管癌，且组织学检查发现为胆管细胞癌与肝细胞癌混合存在，提示PD术后胆管癌为异时性发生。行扩大右半肝切除术，完整切除残留的肝外胆管，并安全地进行空肠袢节段性切除，无手术死亡或严重术后并发症。2例患者术后6个月死于肿瘤复发，其余1例患者术后17个月目前生活正常，无复发迹象。这些手术方法是PD术后发生的肝门部胆管周围癌患者的一种治疗选择。
