胆管内乳头状肿瘤手术治疗39例疗效分析

Curative effect of intraductal papillary neoplasm of the bile duct:a retrospective analysis of 39 cases

目的:探讨胆管内乳头状肿瘤(IPNB)的诊断与手术治疗方法。方法:回顾分析2020年1月至2023年12月收治的病理确诊的39例IPNB患者的临床资料,其中男21例,女18例,平均(65.44±9.64)岁。12例首发症状为腹痛,10例为黄疸。肝内型IPNB 19例(48.7%),肝外型IPNB 20例(51.3%),合并浸润癌27例(69.2%)。结果:39例患者中10例行腹腔镜手术治疗,其中男性与女性各5例,平均(66.80±8.78)岁,肝内型IPNB 4例,肝外型IPNB 6例,肿瘤最大直径(2.71±1.53)cm,手术时间平均(274.10±69.02)min,术中出血量150.00(87.50,200.00)mL,术后平均住院(11.00±3.02)d,术后发生胰瘘2例,病理显示合并浸润癌7例。腹腔镜手术组与开腹手术组手术时间、术中出血量、术后住院时间、术后并发症发生率差异无统计学意义。结论:IPNB是临床少见的胆道肿瘤,术前经磁共振、内镜逆行胰胆管造影检查,结合患者症状可大大提高诊断率。腹腔镜手术是治疗IPNB安全、可靠的术式。

Objective:To investigate the diagnosis and surgical treatment of intraductal papillary neoplasm of the bile duct(IPNB).Methods:The clinical data of 39 patients with IPNB confirmed by pathology who underwent surgical treatment between Jan.2020 and Dec.2023 were retrospectively analyzed.The surgical experience and treatment experience were summarized.In the total 39 patients,there were 21 males and 18 females.The age was(65.44±9.64)years old.The first symptoms were abdominal pain in 12 patients and jaundice in 10 patients.The number of intrahepatic bile duct pattern and extrahepatic bile duct pattern was 19(48.7%)and 20(51.3%),respectively.27 patients(69.2%)were combined with invasive carcinoma.Results:Ten patients received laparo-scopic surgery.Laparoscopic group included 5 females and 5 males.The mean age was(66.80±8.78)years old.The number of intra-hepatic bile duct pattern and extrahepatic bile duct pattern of laparoscopic group was 4 cases and 6 cases,respectively.The maximum diameter was(2.71±1.53)cm.The operation time was(274.10±69.02)min.Blood loss was 150.00(87.50,200.00)mL.The post-operative hospital stay was(11.00±3.02)d.Pancreatic fistula was found in 2 patients.7 cases were combined with invasive carcinoma.There were no significant differences in operation time,blood loss,postoperative hospital stay and postoperative complications between laparoscopic group and laparotomy group.Conclusions:IPNB is a rare bile duct tumor.It will improve diagnosis rate greatly to carry out preoperative magnetic resonance imaging and endoscopic retrograde cholangiopancreatography combined with symptoms of the patients.Surgical treatment is the main treatment option.Laparoscopic surgery is a safe and reliable procedure in the treatment of IPNB.