肝内胆管囊腺瘤的诊断与治疗

Diagnosis and treatment of intrahepatic biliary cystadenoma

目的:探讨肝内胆管囊腺瘤的临床特点,从而提高对该疾病的认识,减少误诊率.方法:复习南昌大学第二附属医院2009-01/2013-01收治的11例病理诊断为肝内胆管囊腺瘤的病例,回顾其术后病理结果、临床表现,影像学特点,外科治疗效果及预后,结合相关文献资料,总结肝内胆管囊腺瘤的特点.结果:总共11例,其中男1例,年龄49,女10例,平均年龄为54.5岁±2.0岁.临床表现主要是上腹部胀痛不适,2例出现黄疸.影像资料提示肝内胆管扩张,肿块病变呈囊性或囊实性,其中1例伴有胆结石,2例伴有肝内胆管结石,2例伴有胆囊息肉.术后病理诊断:肝内胆管囊腺瘤5例、肝内胆管黏液性囊腺瘤2例,肝内胆管乳头状囊腺瘤2例,肝内胆管交界性囊腺瘤2例.治疗方式:肿瘤均手术完整切除,随访期间均未复发.结论:肝内胆管囊腺瘤好发于中年女性,临床表现不具有特异性,B超、计算机断层扫描(computed tomography)、磁共振成像(magnetic resonance imaging)、磁共振胰胆管成像(magnetic resonance cholangiopancreatography)等技术有助于提高该疾病的诊断及术前评估,治疗上首选手术治疗,推荐囊肿全部切除加周围部分正常肝组织切除术.

AIM： To explore the clinical features of intra-hepatic biliary cystadenoma, so as to raise awareness of the disease and reduce the mis-diagnosis rate.METHODS： Clinical data for 11 intrahepatic biliary cystadenoma patients treated from January 2009 to August 2013 at the Second Affiliated Hospital of Nanchang University were analyzed retrospectively. The clinical manifestations, imaging features, surgical and pathological characteristics were summarized.RESULTS： There were one male（age, 49 years） and 10 females（mean age, 54.5 years ± 2.0 years）. Main clinical manifestations were abdominal pain and discomfort, and two cases had jaundice. Imaging data showed intrahepatic bile duct dilatation and cystic or solid mass lesions; one patient had gallstones, two had intrahepatic bile duct stones, and two had gallbladder polyps. Pathological examinations showed five cases of intrahepatic biliary cystadenoma, two cases of mucinous cystad-enoma, two cases of papillary cystadenoma, and two cases of borderline cystadenoma. All patients underwent complete surgical resection, and no recurrence was observed during follow-up. CONCLUSION： Intrahepatic biliary cystad-enoma often occurs in middle-aged women, and its clinical manifestations are not specific. Ultrasound, computed tomography, magnetic resonance imaging, and magnetic resonance cholangiopancreatography can help improve the diagnosis and preoperative assessment of the disease. Complete resection is recommended for the treatment of this disease.