胆管内乳头状肿瘤的临床病理分析

A clinicopathologic study of biliary intraductal papillary neoplasm

目的探讨胆管内乳头状肿瘤（IPN—B）的临床病理特点及诊治方法。方法总结1998年1月至2007年12月收治的23例IPN—B患者的临床资料，对其临床表现、病理特点、诊治及预后进行临床分析。结果23例患者中男性13例，女性10例，年龄30—80岁，平均（61±12）岁。首发症状：无症状10例、腹痛7例、黄疸4例、表现为体质量下降和急性胆管炎者各1例；9例患者同时伴有胆管结石。肿瘤平均直径为（6±4）cm，位于肝右叶胆管4例、位于肝左叶胆管15例、位于肝外胆管4例。其中腺瘤4例、交界性肿瘤1例、原位癌6例、侵袭性癌12例。23例IPN—B患者均经手术切除病灶，平均随访时间为（33±28）个月，3年及5年生存率分别为85．3％和68．2％。结论IPN—B是少见具有独特临床病理学特点的胆管肿瘤，手术切除是最佳治疗手段，预后较好。

Objective To investigate the clinicopathologic features, diagnosis and treatment of biliary intraductal papillary neoplasm （ IPN-B ）. Methods The clinical, histopathological, treatment and prognosis data of 23 patients with IPN-B treated from January 1998 to December 2007 were retrospectively analyzed. Results There were 13 male and 10 female, aged from 30 to 80 years[ mean age was （61 _＋ 12） years ]. The clinical manifestation included 10 eases with asymptomatic,7 cases with abdominal pain, 4 cases with jaundice, 1 case with emaciation, and 1 case with acute eholangitis, respectively. Nine patients were also associated with hepatolithiasis. The average diameter of the tumors was （6 _＋4） cm,4 lesions were located in the right lobe, 15 in the left lobe, and 4 in the extrahepatic bile duct. Histopathologically, there were 4 adenomas, 1 borderline neoplasm ,6 carcinomas in situ, and 12 carcinomas. All patients received operation ; the mean duration of follow-up was （ 33 _＋ 28 ） months. Overall 3-year and 5-year survival rates of IPN-B were 85.3% and 68. 2% respectively. Condusions IPN-B represents a distinct clinicopathologic entity. Favorable prognosis for IPN-B is offered by curative resection.