胆管乳头状瘤14例的临床病理及外科治疗

Biliary papillary adenoma and papillomatosis： a report of 14 cases

目的 探讨胆管乳头状瘤的临床病理特点、诊断及治疗方法。方法 对1993年1月至2006年6月经病理证实的14例胆管乳头状瘤的临床资料进行回顾性分析。结果 胆管乳头状瘤的主要临床表现为上腹部疼痛、黄疸及急性胆管炎。胆管乳头状瘤单发6例，多发8例；肿瘤位于肝外胆管6例，肝内胆管5例，肝内外胆管3例；伴轻中度不典型增生5例，癌变6例。术前影像学确诊2例。术后胆道镜检查发现病灶2例。14例患者均行手术治疗，6例肿瘤早期完全切除者术后无复发，3例癌变浸润者生存期在8个月内。结论 胆管乳头状瘤是具有很高恶变潜能的癌前疾病，术前确诊困难。MRCP和胆道镜检查有较高的诊断价值。胆管乳头状瘤单发者应早期行肿瘤局部切除，多发者治疗困难；根治性手术切除是主要治疗方法。

Objective To investigate the clinicopathogy, diagnosis and treatment of biliary papinary adenoma and biliary papinomatosis. Methods The clinical and pathological data of 14 cases in recent 14 years were studied retrospectively. Results There were 6 cases of biliary papillary adenoma and 8 cases of biliary papinomatosis. The common clinical manifestations at the presentation were repeated episodes of abdominal pain, jaundice, and acute cholangitis. Tumors were located at the extrahepatic duct in 6 cases, in intrahepatic duct in 5 cases and widespread in 3 cases. Mild-moderate dysplasia （5 cases） and malignancy （6 cases） were detected histologically. Only 2 cases were diagnosed preoperatively. An 14 patients undergoing operation and the 6 patients receiving curative resection of the primary lesions were doing well without recurrence at fonow-up. Conclusions Biliary papillary adenoma and papillomatosis should be regarded as a premalignant disease with high malignant potential. MRCP and choledochoscopy are needed for the diagnosis. Local resection of biliary papillary adenoma should be performed early. The management of biliary papillomatosis is difficult. Curative resection is the primary therapy.