Akiyama T, Hasegawa T, Sejima T, Sahara H, Kitabayashi K, Seto K, Saito H, Takashima S
Department of General and Digestive Surgery, Kanazawa Medical University, Ishikawa, Japan.
J Gastroenterol. 1998 Aug;33(4):597-601. doi: 10.1007/s005350050141.
We report a case of anomalous junction of the pancreaticobiliary duct (AJPBD) associated with gallbladder cancer and obstructive jaundice in a patient with high serum and bile cytokine levels. The patient was a 63-year-old woman who complained of right hypochondralgia. Ultrasound, computed tomography, percutaneous transhepatic cholangiography, and endoscopic retrograde cholangio-pancreatatography revealed dilation of the bile ducts, an elevated lesion of the gallbladder, and AJPBD. She underwent percutaneous transhepatic cholangio-drainage (PTCD) for obstructive jaundice. However, the total bilirubin concentration remained high 7 days after PTCD. Her serum interleukin 6 level was 57,359 pg/ml before PTCD, and gradually decreased to 10 pg/ml after PTCD. Bile interleukin 6 level was 10 pg/ml before PTCD, 8997 pg/ ml 3 h after PTCD and gradually decreased there after. Serum and bile levels of tumor necrosis factor alpha and hepatocyte growth factor were high before and after PTCD. The patient underwent an extended cholecystectomy and resection of the extrahepatic bile duct. The resected specimen showed two elevated lesions of the gallbladder which, microscopically, revealed moderately differentiated tubular adenocarcinoma. These findings suggest that pre-existing inconspicuous inflammation of the biliary tract due to reflux of pancreatic juice is involved in elevation of serum and bile cytokines, and that cytokines may participate in gallbladder carcinogenesis associated with AJPBD.
我们报告一例胰胆管异常连接（AJPBD）合并胆囊癌及梗阻性黄疸的病例，该患者血清和胆汁细胞因子水平升高。患者为一名63岁女性，主诉右季肋部疼痛。超声、计算机断层扫描、经皮经肝胆道造影及内镜逆行胰胆管造影显示胆管扩张、胆囊占位性病变及AJPBD。因梗阻性黄疸，她接受了经皮经肝胆道引流（PTCD）。然而，PTCD术后7天总胆红素浓度仍居高不下。PTCD术前她的血清白细胞介素6水平为57359 pg/ml，PTCD术后逐渐降至10 pg/ml。PTCD术前胆汁白细胞介素6水平为10 pg/ml，PTCD术后3小时为8997 pg/ml，之后逐渐下降。PTCD术前及术后肿瘤坏死因子α和肝细胞生长因子的血清及胆汁水平均较高。患者接受了扩大胆囊切除术及肝外胆管切除术。切除标本显示胆囊有两个占位性病变，显微镜下为中分化管状腺癌。这些发现提示，胰液反流导致的先前不明显的胆道炎症与血清和胆汁细胞因子升高有关，且细胞因子可能参与了与AJPBD相关的胆囊致癌过程。
