胆管乳头状瘤病23例的诊断与治疗

Diagnosis and treatment for 23 cases of biliary papillomatosis

目的 探讨胆管乳头状瘤病的诊断与治疗.方法 回顾性分析我院2003年1月至2008年3月收治并经病理诊断为胆管乳头瘤病23例的临床资料,对其年龄、性别、临床表现、诊断、病理学发现、术中发现、治疗及预后进行分析.结果 23例的男女之比为1.3∶1,平均年龄49.5岁.主要临床表现为腹痛（83.3%）和黄疸（72.2%）.术前均未确诊,术中均行冰冻切片病理学检查并获确诊.解剖学方面,单发病灶10例（43.5%）和多发性病灶13例（56.5%）,肿瘤平均直径为2.6 cm.光镜下,轻度不典型增生3例,中度不典型增生1例,癌变1例.治疗主要为根治切除术和姑息性外引流术.术后除1例出现吻合口瘘外,余均恢复良好,并均获随访,平均随访期34个月.随访期间,3例因恶变死亡,1例复发,余无复发.结论 胆管乳头状瘤病术前诊断相当困难,目前主要依赖术中及术后的病理学检查.为获得较好的预后,治疗上应行根治性切除,并提倡使用术中胆道镜检查及冰冻病理切片指导最佳治疗方式的选择.

Objective To investigate the diagnosis and treatment for biliary papillomatosis. Methods 23 patients who were pathologically diagnosed as biliary papillomatosis and treated in our hospital from Jan. 2003 to Mar. 2008 were enrolled in this study. Their ages, genders, clinical manifestations, diagnostic approaches,histopathological findings, intraoperative findings, treatments and prognosis were analyzed retrospectively. Recal manifestations were abdominal pain （83.3%） and obstructive jaundice （72.2%）. All the patients were diagnosed pathologically through intraoperative frozen section. No patient was diagnosed preoperatively. Anatomically, solitary lesion was observed in 10 patients （43.5%） and multiple lesions in 13 patients （56.5%）, with a median tumor size of 2.6 cm. Microscopically, carcinomatous change was found in one patient, mild atypical hyperplasia in three, and medium atypical hyperplasia in one. Therapies mainly included radical excision and palliative external drainage. All but one patient recovered well postoperatively. This patient had anastomotic leak. All 23 patients were followed up with a mean period of 34 months. During the follow-up, three patients died as a consequence of biliary malignancy, one patient had the recurrence and others without recurrence. Conclusions Biliary papillomatosis is very difficult to diagnose preoperatively and the definitive diagnosis mainly depends on intraoperative and postoperative pathologic examination. To obtain a better prognosis, management should be aimed at radical excision. Intraoperative cholangioscopic evaluation and frozen section are strongly recommended to guide the choice of appropriate therapeutic approach.