摘要
目的提高胆囊癌累及肝外胆管时的诊治水平。方法回顾性分析我院从1999年1月-2005年7月收治的26例经手术及病理证实为胆囊癌累及肝外胆管者病历资料。结果26例中1例漏诊。CT、MRI、ERCP及MRCP明确为胆囊癌原发灶侵犯肝总管和/或胆总管18例;MRCP或ERCP示胆总管中下段外压切迹和管腔轻度变形5例,经手术证实为转移淋巴结侵及胆管壁,1例胆总管十二指肠后段管壁僵硬,长约0.5cm,1例肝总管左侧壁僵硬,长约1cm,经手术证实为"跳跃式"转移癌。15例行了不同范围的扩大切除术,10例行单纯胆道引流术。漏诊1例1月后再次手术行了胆管十二指肠架桥引流术。全部获随访。行扩大切除手术15例中,存活14月-23月6例,24月-60月或以上者9例。结论胆囊癌非直接侵润方式累及肝外胆管并不少见,术前MRCP或ERCP检查,术中仔细探查肝外胆管周围情况,是避勉漏诊的关键。合理的选择扩大手术方式才能使患者获得较长生存时间。
Objective To improve level on diagnosing and curing gallbladder cancinoma involving extra hepatic biliary duct. Method Reviewing and analyzing and surgery, were confirmed from Jan. 1999 to Jul. 2005 suffering from ballblader cancinoma invillving extra hepatic biliary duct. Results With one case neglected for the 26 cases, 18 cases of CT, MRI, ERCP and MRCP were confirmed as gallbladder cancinoma＇s primary focus that affect the extra hepatic biliary duct while 5 cases of MRCP or ERCP has shown that the notch from pressing cut at middle and lower section of choledochus and duct cavity slightly distorted, which, by surgery, has been confirmed as choledochus wall aws affected by the ambulant lymph node. And one case has shown choledochus wall became stiff at section behind duodenum, with length about 0.5cm and another one cases is stiff at the left wall of the common hepatic duct, length about lcm that, by surgery, was confiemed as transferred cancer with socalled ＂leap pattern＂. Of the 26 cases 15 ones have been done with enlarged resection at different extent and 10 cases done with onefold hepatocholangiostomy. One month later, the neglected cases was done with hepatocholangiostomy. All the 26 cases were followed-up survey. For the 15 cases teated with enlarged resection,six survived up to 14 months-23 months and nine up to 24 months 60 months. Conclusion Actually, it has been no less seem that extra hepatic biliary duct was indirectly affected by gallbladder cancinoma and to avoid diagnosis overlooked the key is to take MRCP or ERCP and to carefully probe the situation around extra hepatic biliary duct while reasonably making choice of enlarged surgery is the only effective scheme to ensure the patients surviving for longer time.
