Tanaka K, Ikoma A, Hamada N, Nishida S, Kadono J, Taira A
Second Department of Surgery, Kagoshima University, Japan.
Am J Surg. 1998 Mar;175(3):218-20. doi: 10.1016/s0002-9610(97)00288-2.
Anomalous junction of the pancreaticobiliary ductal system (AJPBDS) is a congenital anomaly in which the junction is located outside the duodenal wall. Recently, attention has been focused on the high incidence of malignancy in this anomaly. The purpose of this study was to clarify the clinicopathological features of this anomaly and to determine the appropriate surgical approach for biliary tract cancer associated with AJPBDS.
The data for 38 patients with AJPBDS, including 14 who had been treated for biliary tract cancer (2 with bile duct cancer and 12 with gallbladder cancer), were retrospectively reviewed. We assessed the clinical features, characteristics of the tumor, operative procedure, and outcome for each patient.
The incidence of malignancy in AJPBDS was 17.8% (2 patients with bile duct cancer and 3 with gallbladder cancer) in the bile duct dilatation group (n = 28) and 90% (9 patients with gallbladder cancer) in the no-dilatation group (n = 10) . The mean length of the common channel was 24.7 mm (range 20 to 35 mm) . Resection with lymphadenectomy was performed in 9 (64.3%) of 14 patients, and curative resection in 5 of these 9 patients. Ten (71%) of the 14 patients had lymph node involvement noted either at the time of initial diagnosis or at surgery. The incidence of lymph node metastasis was closely related to the depth of tumor involvement. Ten patients died of recurrence or primary cancer, from 3 to 30 months after operation. Four patients are still alive without recurrent disease from 2.5 to 13 years after operation.
For patients with AJPBDS without bile duct dilatation, prophylactic cholecystectomy is recommended even if no malignant lesion is found in the gallbladder because of the high incidence of gallbladder cancer and the poor prognosis. Both early detection and curative resection of the tumor are essential for successful treatment of biliary tract cancer.
胰胆管系统异常连接（AJPBDS）是一种先天性异常，其连接位于十二指肠壁外。近来，该异常中恶性肿瘤的高发病率受到关注。本研究的目的是阐明这种异常的临床病理特征，并确定与AJPBDS相关的胆道癌的合适手术方法。
回顾性分析38例AJPBDS患者的数据，其中14例接受了胆道癌治疗（2例胆管癌，12例胆囊癌）。我们评估了每位患者的临床特征、肿瘤特点、手术操作及预后。
胆管扩张组（n = 28）中AJPBDS的恶性肿瘤发生率为17.8%（2例胆管癌和3例胆囊癌），无扩张组（n = 10）中为90%（9例胆囊癌）。共同通道的平均长度为24.7毫米（范围20至35毫米）。14例患者中有9例（64.3%）进行了切除加淋巴结清扫，其中9例中有5例为根治性切除。14例患者中有10例（71%）在初次诊断或手术时发现有淋巴结受累。淋巴结转移发生率与肿瘤浸润深度密切相关。10例患者在术后3至30个月死于复发或原发癌。4例患者术后2.5至13年仍存活且无疾病复发。
对于无胆管扩张的AJPBDS患者，由于胆囊癌发病率高且预后差，即使胆囊未发现恶性病变，也建议行预防性胆囊切除术。肿瘤的早期检测和根治性切除对于胆道癌的成功治疗至关重要。
