肝内胆管囊腺瘤的诊断与外科治疗  

Diagnosis and treatment of intrahepatic biliary cystadenoma

作　　者：姜楠[1] 张平 纪文斌[1] 余强[1] 罗英[1] Jiang Nan;Zhang Ping;Ji Wenbin;Yu Qiang;Luo Ying(Faculty of Hepato-Pancreato-Biliary Surgery,Chinese PLA General Hospital,Beijing 100853,China;Department of Hepatobiliary Surgery,Heze Municipal Hospital,Heze 247000,China)

机构地区：[1]解放军总医院肝胆胰外科医学部,北京100853 [2]菏泽市立医院肝胆外科,菏泽247000

出　　处：《中华肝胆外科杂志》2022年第10期751-754,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的:探讨肝内胆管囊腺瘤(BCA)的诊断及治疗方法。方法:回顾性分析2010年3月至2021年1月在解放军总医院行根治性手术切除的86例BCA患者的临床资料,其中男性15例,女性71例,年龄(48.4±13.1)岁。依据手术方式分为微创组44例和开腹组42例。收集患者影像学资料、血生化、肿瘤标志物等临床资料。采用电话和门诊复查的方式随访。结果:86例BCA患者的肿瘤中,病灶为单囊性19例(22.1%),多囊性67例(77.9%);囊内伴有分隔64例(74.4%),囊内壁伴有附壁结节12例(14.0%)。回顾患者病史,86例BCA患者根治手术前误诊为肝囊肿9例(10.4%),肝包虫病2例(2.3%),肝内胆管错构瘤1例(1.2%),肝血管瘤1例(1.2%)。与开腹组相比,微创组患者的肿瘤长径[(6.5±3.2)比(9.0±4.0)cm]、手术时间[115(88,185)比195(160,254)min]、术中出血量[50(20,162)比300(200,600)ml]、术后住院时间[4(3,6)比8(7,10)d]均减少,差异具有统计学意义(P<0.05)。73例患者获得随访,中位随访时间63.5个月,4例出现BCA复发。结论:BCA缺乏特异性的临床表现,误诊和误治率较高。治疗原则应以根治性肝切除手术为主,条件允许的情况下,建议优先考虑微创手术。Objective To study the clinical features of intrahepatic biliary cystadenoma(BCA),with the aim to improve its treatment results.Methods The clinical data and follow-up results of 86 patients with BCA treated at our department from March 2010 to January 2021 were retrospectively analyzed.Of 86 patients,there were 15 males and 71 females,with age of(48.4±13.1)years old.According to the surgical procedures carried out,44 patients were divided into the minimally invasive group and 42 into the open group.Clinical data including imaging data,blood biochemistry,and tumor markers were collected.The follow-up data of these patients was collected in outpatient clinics or by telephone review.Results Of 86 patients,19(22.1%)patients had a monocystic lesion while 67(77.9%)patients had a multicystic lesion,64 patients(74.4%)had intracapsular segregation,and 12(14.0%)patients had solid structures.Eighty-six patients with BCA were misdiagnosed as hepatic cysts in 9 patients(10.4%),hepatic echinococcosis in 2 patients(2.3%),biliary hamartoma in 1 patient(1.2%),and hepatic hemangioma in 1 patient(1.2%)before surgery.The tumor size[(6.5±3.2)vs.(9.0±4.0)cm],operative time[115(88,185)vs.195(160,254)min],intraoperative blood loss[50(20,162)vs.300(200,600)ml],and postoperative hospital stay[4(3,6)vs.8(7,10)d]were significantly lower in the minimally invasive group than the open group.The differences were statistically significant(P<0.05).In the 73 patients with complete follow-up,(median follow-up 63.5 months),4 patients had developed tumor recurrence.Conclusion Intrahepatic bile duct cystadenoma lacks specific clinical manifestations,and has a high rate of misdiagnosis and mistreatment.Early radical hepatectomy improved clinical outcomes.

关 键 词：诊断 鉴别 预后 肝内胆管囊腺瘤 肝囊性病变 

分 类 号：R735.8[医药卫生—肿瘤]