136例胆管良性肿瘤外科诊断与治疗的多中心回顾性研究  

Surgical diagnosis and treatment for benign tumor of the bile ducts in 136 patients： a multicenter retrospective study

作　　者：邱应和[1] 魏妙艳 巩鹏[3] 耿智敏[4] 李升平[5] 何字[6] 翟文龙[7] 李敬东[8] 汤朝晖[2] 

机构地区：[1]第二军医大学附属东方肝胆外科医院胆道二科,上海200438 [2]上海交通大学医学院附属新华医院普通外科,200092 [3]大连医科大学附属第一医院普通外科,116011 [4]西安交通大学第一附属医院肝胆外科,710061 [5]中山大学肿瘤防治中心肝胆科,广州510060 [6]第三军医大学西南医院全军肝胆外科研究所中国人民解放军西南肝胆外科医院,重庆400038 [7]郑州大学第一附属医院肝胆胰外科,450052 [8]川北医学院附属医院肝胆外科, 南充637000

出　　处：《中华消化外科杂志》2017年第4期368-374,共7页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金（81572420、81270533、81473504）;上海市科委“科技创新行动计划”项目（15441903702）;辽宁省百千万人才工程;河南省科技创新人才支持计划（14HASTIT030）

摘　　要：目的探讨胆管良性肿瘤的流行病学特征、临床表现特点、诊断、治疗及预后情况。方法采用多中心回顾性横断面研究方法。收集2007年1月至2016年12月国内8家医院收治的136例（第二军医大学附属东方肝胆外科医院70例、郑州大学第一附属医院19例、西安交通大学第一附属医院15例、大连医科大学附属第一医院11例、川北医学院附属医院7例、第三军医大学西南医院6例、中山大学肿瘤防治中心4例、上海交通大学医学院附属新华医院4例）胆管良性肿瘤患者的临床资料。患者均行实验室和影像学检查，根据其临床表现及检查结果由各医疗中心制订治疗方案，行相应手术治疗．术中常规行快速冷冻切片病理学检查，根据术中病理学检查结合患者实际病情决定手术方式。观察指标：（1）流行病学特征。（2）临床表现特点。（3）实验室及影像学检查结果。（4）治疗情况。（5）随访情况。采用门诊和电话方式进行随访，了解患者生存情况。随访时间截至2017年3月。符合正态分布的计量资料采用-jj±s表示。结果（1）流行病学特征：136例患者中，男女比例为1．78：1；发生率由高到低，依次为十二指肠乳头腺瘤52例、肝外胆管腺瘤32例、肝内胆管囊腺瘤24例、肝内胆管乳头状瘤11例、肝内胆管上皮内瘤变9例、十二指肠乳头上皮内瘤变7例、十二指肠乳头部神经内分泌瘤1例。136例患者中，腺瘤（含囊腺瘤）108例，乳头状瘤11例，上皮内瘤变16例，神经内分泌瘤1例；肝内胆管良性肿瘤44例，肝外胆管（含十二指肠乳头）良性肿瘤92例。（2）临床表现特点：44例肝内胆管良性肿瘤患者中．29例临床表现主要为腹痛、发热、腹部包块．4例出现黄疸，11例患者无明显临床症状，于健康体检时发现。92例肝外胆管良性肿瘤患者中，76例出现梗阻性黄疸，68例伴有腹痛�Objective To investigate the epidemiological characteristics, clinical features, diagnosis, treatment and prognosis of benign tumor of the bile ducts. Methods The retrospective cross-sectional multicenter study was conducted. The clinical data of 136 patients with benign tumor of the bile ducts who were admitted to the eight hospitals between January 2007 and December 2016 were collected, including 70 in the Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University, 19 in the First Affiliated Hospital of Zhengzhou University, 15 in the First Affiliated Hospital of Xi＇an Jiaotong University, 11 in the First Affiliated Hospital of Dalian Medical University, 7 in the Affiliated Hospital of North Sichuan Medical College, 6 in the Southwest Hospital of the Third Military Medical University, 4 in the Cancer Center of Sun Yat-Sen University and 4 in the Xiuhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. All the patients received laboratory and imaging examinations, and then underwent corresponding surgery when treatment planning was respectively determined by comprehensive hospitals according to clinical features and results of examinations. Surgical procedures were performed based on the results of intraoperative frozen section in rapid pathological diagnosis. Observation indicators： （1） epidemiological characteristics; （2） clinical features; （3） results of laboratory and imaging examinations ; （4） treatment situations ; （5） follow-up situations. Follow-up using outpatient examination and telephone interview was performed to detect the survival of patients up to March 2017. Measurement data with normal distribution were represented as x^-±s . Results （ 1 ） Epidemiologieal characteristics ： Of 136 patients, the male to female ratio was 1.78 ： 1. The incidence of whole bile duct tumors was from high to low, including 52 patients with duodenal papilla adenoma, 32 with extrabepatic bile duct adenoma, 24 with intrahepatic biliary cystadenom

关 键 词：胆管良性肿瘤 诊断 外科手术 多中心 回顾性研究 

分 类 号：R735.8[医药卫生—肿瘤]