CAJ | 학술논문

目的探讨肝内胆管黏液性肿瘤(mucin-producing intrahepatic biliary tumor,MPIBT)的诊断与治疗方法.方法回顾性分析福建省立医院肝胆外科2004-2011年收治的16例MPIBT患者的临床资料.结果 16例中男6例,女10例,年龄44～ 69岁,平均60岁.主要临床表现为黄疸合并上腹疼痛5例,急性胆管炎4例,无痛性黄疸2例；上腹疼痛不适3例；无明显症状l例；3个月内体重减轻＞5 kg者5例.MPIBT的磁共振胰胆管成像(MRCP)最主要特征为肝内胆管不对称性扩张和远离肿块的肝内外胆管扩张而无肝外胆管的突然截断.原发肿瘤位于左肝胆管15例,右肝胆管l例.行半肝切除13例,其中胆肠吻合8例；3例行姑息性胆道引流术.病理学诊断:肝内胆管黏液腺癌13例,肝内胆管黏液腺瘤3例.l、2、3年生存率分别为81％、66％、56％.结论 MPIBT临床表现无特异性,MRCP有助于明确诊断与判断肿瘤累及范围,根治性切除是其首选治疗方法,姑息性胆道引流能延长患者生存时间.
목적 탐토간내담관점액성종류(mucin-producing intrahepatic biliary tumor,MPIBT)적진단여치료방법.방법 회고성분석복건성립의원간담외과2004-2011년수치적16례MPIBT환자적림상자료.결과 16례중남6례,녀10례,년령44～ 69세,평균60세.주요림상표현위황달합병상복동통5례,급성담관염4례,무통성황달2례；상복동통불괄3례；무명현증상l례；3개월내체중감경＞5 kg자5례.MPIBT적자공진이담관성상(MRCP)최주요특정위간내담관불대칭성확장화원리종괴적간내외담관확장이무간외담관적돌연절단.원발종류위우좌간담관15례,우간담관l례.행반간절제13례,기중담장문합8례；3례행고식성담도인류술.병이학진단:간내담관점액선암13례,간내담관점액선류3례.l、2、3년생존솔분별위81％、66％、56％.결론 MPIBT림상표현무특이성,MRCP유조우명학진단여판단종류루급범위,근치성절제시기수선치료방법,고식성담도인류능연장환자생존시간.
Objective To investigate the diagnosis and treatment of mucin-producing intrahepatic biliary tumor (MPIBT).Methods We retrospectively analyzed the clinical,radiologic,surgical and pathologic findings of 16 MPIBT cases from January 2004 to December 2011.Results There were six men and ten women,age ranged from 44 to 69 years (mean 60 years).Clinical presentation included jaundice with abdominal dull pain in 5 patients,acute cholangitis in 4 patients,painless jaundice in 2 patients,upper abdominal dull pain in 3 patients,no obvious symptoms in 1 patient,body weight loss more than 5 kg within 3 months in 5 patients.The most characteristic appearance of MPIBT on magnetic resonance cholangiopancreatography were asymmetry of intrahepatic bile duct dilatation and the dilatation in both extraand intrahepatic bile duct distal to the hepatic mass and not sudden interruption in extrahepatic bile duct.The primary tumor located in the left hepatic bile duct in 15 cases,in the right hepatic bile duct in one.13 MPIBT cases received hemihepatectomy and extrahepatic bile duct resection and Roux-en-Y anastomosis was done in 8 cases,3 received palliative biliary drainage.Pathologically 13 was papillary adenocarcinoma and 3 was papillary adenoma.The 1-,2-,3-year survival rates for the 16 MPIBT patients were 81％,66％,56％,respectively.Conclusions MPIBT had no specific clinical manifestations,MRCP might be an effective means for the diagnositic strategy and assessment of tumor extension before surgery,radical resection was the first choice of treatment,palliative biliary drainage could prolong the survival time.