胆总管十二指肠吻合术后42年再发胆管癌(英文)

Cholangiocarcinoma Developing 42-year after Choledochoduodenostomy

胆总管十二指肠吻合术是常用的胆肠吻合方式,曾被公认为是"无害"的手术方式。但近数年来,已有相关报道胆总管十二指肠吻合术后多年可能再发胆管癌,并认为其是继胆管炎以外最严重的并发症。本文报道了1例因肝内外胆管结石行胆总管十二指肠吻合术后42年再发胆管癌的患者,并对有关文献进行回顾与总结,并推荐对施行胆肠吻合术,尤其对于术后多次伴发胆管炎的患者,做常规随访是防止严重并发症的有效方式。

Anastomosis between the biliary tract and the intestinal tract has been, and is, a relatively common procedure. Aside from cholangitis secondary to anastomotic stricture, it is generally regarded as innocuous. However, the correlation between biliary-enteric surgical drainage and the late development of cholangiocarcino- ma of the biliary tract has recently been documented, and has become a serious issue today. It is reported that a case of a 68-year-old woman had developed a cholangiocarcinoma 42-year after choledochoduodenostomy because of choledocholithiasis. Descriptions of cholangiocarcinoma arising after biliary-enteric drainage procedures for benign disease are reviewed. These biliary epithelial changes presumably induced by chronic inflammation due to the reflux of intestinal contents and bile stasis may be responsible for the carcinogenesis. Experimental, clini- cal, and epidemiological data are available to support the hypothesis that a link between cholangiocarcinoma and biliary drainage procedures. Chronic inflammatory changes consequent to biliary-enteric drainage should be closely monitored for the late development of biliary tract malignancies.