肝外胆管腺瘤(2例报道及文献复习)

Adenomas of Extrahepatic Bile Duct:Report of Two Cases and Review of the Literatures

目的 探讨肝外胆管腺瘤的临床表现、病理特征、影像学特征及其诊断和治疗。方法 对我院收治的 2例及复习文献报告的 14例共 16例临床资料进行回顾性分析。结果 男 5例 ,女 11例 ,平均年龄 5 8.4岁 ,其中>5 0岁者占 87.5 %。主要临床表现 :黄疸 11例 ( 6 8.8% ) ,腹痛 8例 ( 5 0 .0 % ) ,发热 6例 ( 37.5 % ) ,消化不良 4例 ( 2 5 .0 % ) ,体重下降 3例 ( 18.8% ) ,陶土色大便 1例 ( 6 .3% )。肿瘤分布部位为左肝管 1例 ( 6 .3% ) ,右肝管 3例 ( 18.8% ) ,肝总管 3例 ( 18.8% ) ,胆囊管汇入胆总管处 1例 ( 6 .3% ) ,胆总管远端 8例 ( 5 0 .0 % )。病理类型为管状腺瘤 5例 ( 31.3% ) ,乳头 (绒毛 )状腺瘤 10例 ( 6 2 .5 % ) ,粘液腺瘤 1例 ( 6 .3% )。 16例均行手术治疗 ,均经病理检查确诊 ,术后肿瘤复发 1例。结论 肝外胆管腺瘤缺乏典型的临床表现 ,术前难以确诊 ,必须依靠病理组织学检查。手术完整切除肿瘤 ,切缘无肿瘤残留是治疗的关健 。

Objective To study the clinical manifestations, pathologic characteristics, imaging features, diagnosis and treatment of adenomas of extrahepatic bile duct.Methods Two cases of adenomas of extrahepatic bile duct in our hospital and 14 cases reported in the literatures were analyzed retrospectively.Results The patients’(male 5, female 11) mean age was 58.4 years (range 21-85). The main manifestations included jaundice ( n =11), abdominal pain ( n =8),fever ( n =6), dyspepsia ( n =4),body weight loss ( n =3) and clay colored stool ( n =1). The locations of tumors were in the left hepatic duct ( n =1), right hepatic duct ( n =3), hepatic common bile duct( n =3),the junction of cystic duct and common bile duct ( n =1),distal common bile duct ( n =8). The pathologic types were tubular adenomas ( n =5), papillary (villous) adenomas ( n =10),and mucous adenoma ( n =1). All the patients underwent surgical therapy. The tumors were identified by postoperative histopathologic examination.Conclusion It is difficult to correctly diagnose adenomas of extrahepatic bile duct before operation, because the clinical manifestations are usually atypical. The definite diagnosis should depend on histopathologic examination. It is the key to completely resect the tumors. Postoperative follow up should be done on regular basis.