胆管导管内乳头状肿瘤的临床病理特征与治疗策略  

Clinicopathological features and treatment strategies of intraductal papillary neoplasm of the bile duct

作　　者：吴昕[1] 李秉璐[1] 郑朝纪[1] 刘卫[1] 洪涛[1] 谢勇[1] 肖剑春[1] 曲强[1] 何小东[1] Wu Xin;Li Binglu;Zheng Chaoji;Liu Wei;Hong Tao;Xie Yong;Xiao Jianchun;Qu Qiang;He Xiaodong(Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院基本外科,100730

出　　处：《中华消化外科杂志》2021年第8期876-882,共7页Chinese Journal of Digestive Surgery

基　　金：中国医学科学院中央级公益性科研院所基本科研业务费专项资金(2019XK320012)。

摘　　要：目的探讨胆管导管内乳头状肿瘤(IPNB)的临床病理特征与治疗策略。方法采用回顾性描述性研究方法。收集2000年8月至2020年4月中国医学科学院北京协和医院收治的40例IPNB病人的临床病理资料;男19例,女21例;年龄为(60±14)岁。病人术前均行影像学检查和血液检验,判断肿瘤位置和范围,评估其可切除性。根据病人实际情况和意愿选择治疗方式。观察指标:(1)术前检查和检验结果。(2)治疗情况。(3)病理学检查情况。(4)随访情况。采用门诊、电话和网络问诊等方式进行随访。了解肿瘤复发和病人生存情况。随访时间截至2021年4月。计数资料以绝对数和百分比表示。正态分布的计量资料以x±s表示,偏态分布的计量资料以M(范围)表示。采用Kaplan-Meier方法计算累积生存率和绘制生存曲线。结果(1)术前检查和检验结果:40例病人术前均行影像学检查和血液检验。40例病人中,33例行腹部超声检查,31例行腹部CT检查,21例行磁共振检查,15例行内镜逆行胰胆管造影(ERCP)检查,8例行PET-CT检查,6例行内镜超声检查,部分病人行多种检查。IPNB在影像学检查中主要表现为胆管扩张及管腔内肿瘤,CT增强扫描检查结果显示肿瘤强化。术前血液检验结果显示:40例病人中,21例肝功能异常,17例胆红素升高;9例癌胚抗原升高,24例CA19-9升高。(2)治疗情况:40例病人中,35例施行手术治疗;5例行ERCP检查及活组织病理学检查,基于病人意愿未行根治性手术切除。35例行手术治疗病人中,20例行半肝或肝叶切除术,8例行胰十二指肠切除术,7例行胆管肿瘤切除术;手术时间为(262±91)min,术中出血量为300 mL(50~2000 mL)。35例手术病人中,6例发生术后并发症,根据Clavien-Dindo并发症分级标准,Ⅰ级3例、Ⅱ级3例。(3)病理学检查情况:40例病人行病理学检查,均诊断为IPNB,其中肝外病灶19例、肝内病灶21例;良性病变20例(低-中级别上Objective To investigate the clinicopathological features and treatment strategies of intraductal papillary neoplasm of the bile duct(IPNB).Methods The retrospective and descriptive study was conducted.The clinicopathological data of 40 patients with IPNB who were admitted to Peking Union Medical College Hospital from August 2000 to April 2020 were collected.There were 19 males and 21 females,aged(60±14)years.Patients underwent preoperative imaging examination and blood test for evaluation of tumor location,range and resectability.The treatment strategies of patients depended on preoperative examination and their own willingness.Observation indicators:(1)preoperative examinations and tests;(2)treatment;(3)pathological examination;(4)follow-up.Follow-up using outpatient examination,telephone interview and online diagnosis was performed to detect tumor recurrence and survival of patients up to April 2021.Count data were represented as absolute numbers and percentages.Measurement data with normal distribution were represented as Mean±SD,and measurement data with skewed distribution were represented as M(range).The Kaplan-Meier method was used to calculate the cumulative survival rate and draw survivla curve.Results(1)Preoperative examinations and tests:40 patients received preoperative imaging examination and blood test.Of 40 patients,33 cases underwent abdominal ultrasonography,31 cases underwent abdominal computed tomography(CT)examina-tion,21 cases underwent magnetic resonance imaging(MRI),15 cases underwent endoscopic retrograde cholangiopancreatography(ERCP),8 cases underwent position emission tomography CT examination,6 cases underwent endoscopic ultrasonography;some patients underwent multiple examinations.The main imaging features of IPNB were bile duct dilatation,and intraluminal tumor.Enhanced CT scan showed tumor reinforcement.Preoperative blood tests showed of the 40 patients,21 cases with abnormal liver function,17 cases with increased bilirubin,9 cases with increased carcinoembryonic antigen,and 24 c

关 键 词：胆道肿瘤 胆管导管内乳头状肿瘤 手术治疗 淋巴结转移 累积生存率 预后 

分 类 号：R735.8[医药卫生—肿瘤]