先天性胆管扩张症的癌变(附8例报告)

The Canceration of Congenital Bile Duct Dilatation-A Report of 8 Cases

目的:探讨先天性胆管扩张症(CBD)的癌变原因和预防。方法:总结和分析8例CBD癌变患者的发病年龄、性别、癌变部位、组织学分类、手术方式和术后生存期。结果:8例中5例属Ⅰc型,3例属Ⅳa型。5例行囊肿内引流,1例行囊肿外引流。Ⅳa型患者均合并肝内外胆管结石及反复的胆道感染。癌变7例发生在囊肿壁,1例发生在胆囊壁。结论:囊肿的存在是诱发癌变的主要因素。预防CDB癌变的首要方法是切除扩张的肝内外胆管并建立通畅的胆肠内引流。对不能切除的肝内扩张胆管应采用B-US定期随访,以期早期发现癌变。传统的囊肿内引流术应该放弃。

Objective:To probe the cause of canceration of bile duct dilatation(CBD)and its preventive methods.Methods:The age,sex,site of canceration,histological types,opera-tion Method and survival time of8patients with CBD were analysed and studied.Results:A-mong the8patients,5were Ic type and the3wereⅣa type.Internal drainage were per-formed in5patients and external drainage in one case.All patients withⅣa type had intra-hepatic and extrahepatic duct stones and reduplicate biliary infection.Five patients had cancera-tion on the wall of dilated bile duct and one on the wall of gall bladder.Conclusion:Dilata-tion of bile duct is the main predisposing factor of canceration.Resection of the dilated extra-hepatic or intrahepatic ducts and keeping a patent cholangio-enteric drainage are the most im-portant method for prevention of bile duct canceration.For the patients with unresectable dilated intrahepatic duct,periodic surveillance by B-ultrasonography is necessary for early detection of this disease.The traditional internal drainage should be abandoned.