以反复黄疸为临床表现的胆总管下段癌1 例报道并文献复习_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

曾琦惠 , 牛肖雅 ,  叶辉

四川大学华西医院胆道外科（成都 610041）;

Corresponding author：

叶辉, Email: yehuimd@163.com

Keywords：

胆总管下段癌; Vater 壶腹周围肿瘤; 梗阻性黄疸

DOI：

10.7507/1007-9424.202106122

Video：

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目的总结 1 例以反复黄疸为临床特点的胆总管下段癌的不典型临床表现、诊断方法及治疗方式。方法对 2020 年 8 月四川大学华西医院收治的 1 例胆总管下段癌患者的临床资料及诊疗经过进行回顾性分析，并进行相关文献复习，总结该病的诊断方法及治疗方式。结果该例患者以反复黄疸为临床表现，术前常规检查诊断困难，最后经穿刺活检明确为恶性肿瘤，行胰十二指肠切除术，术后组织病理学检查诊断为胆总管下段癌。手术时间 297 min，术中出血量约 200 mL，手术过程顺利。术后无并发症发生，于术后第 11 天出院。术后已随访 6 个月，无不适症状，继续随访。文献复习显示，Vater 壶腹周围肿瘤的具体分型常常根据临床表现及影像学检查进行初步区分，胆总管下段癌以反复黄疸为临床表现者较为罕见，最后确诊需依靠手术切除标本的组织病理学检查。结论胆总管下段癌的恶性程度高，预后差。临床表现不典型的胆总管下段癌，难以早期明确诊断，导致治疗方式选择困难，由此可能会导致患者手术时机延误，内镜或超声引导下的穿刺活检是早期诊断的有效方法之一。

Citation： 曾琦惠, 牛肖雅, 叶辉. 以反复黄疸为临床表现的胆总管下段癌1 例报道并文献复习. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(12): 1645-1647. doi: 10.7507/1007-9424.202106122 Copy

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7.	Verbeke CS, Gladhaug IP. Resection margin involvement and tumour origin in pancreatic head cancer. Br J Surg, 2012, 99(8): 1036-1049.
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9.	Mohamadnejad M, DeWitt JM, Sherman S, et al. Role of EUS for preoperative evaluation of cholangiocarcinoma: a large single-center experience. Gastrointest Endosc, 2011, 73(1): 71-78.
10.	Yamaguchi K, Enjoji M, Kitamura K. Endoscopic biopsy has limited accuracy in diagnosis of ampullary tumors. Gastrointest Endosc, 1990, 36(6): 588-592.
11.	Noor MT, Vaiphei K, Nagi B, et al. Role of needle knife assisted ampullary biopsy in the diagnosis of periampullary carcinoma. World J Gastrointest Endosc, 2011, 3(11): 220-224.
12.	Inoue T, Kitano R, Kobayashi Y, et al. Assessing the diagnostic yield of controllable biopsy-forceps for biliary strictures. Scand J Gastroenterol, 2018, 53(5): 598-603.

1. Oliai A, Koff RS. Disappearance and prolonged absence of jaundice and hyperbilirubinemia in carcinoma of the ampulla of Vater. Am J Gastroenterol, 1973, 59(6): 518-521.
2. Yeo CJ, Sohn TA, Cameron JL, et al. Periampullary adenocarcinoma: analysis of 5-year survivors. Ann Surg, 1998, 227(6): 821-831.
3. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin, 2016, 66(1): 7-30.
4. Westgaard A, Tafjord S, Farstad IN, et al. Pancreatobiliary versus intestinal histologic type of differentiation is an independent prognostic factor in resected periampullary adenocarcinoma. BMC Cancer, 2008, 8: 170.
5. Westgaard A, Pomianowska E, Clausen OP, et al. Intestinal-type and pancreatobiliary-type adenocarcinomas: how does ampullary carcinoma differ from other periampullary malignancies? Ann Surg Oncol, 2013, 20(2): 430-439.
6. Elebro J, Heby M, Gaber A, et al. Prognostic and treatment predictive significance of SATB1 and SATB2 expression in pancreatic and periampullary adenocarcinoma. J Transl Med, 2014, 12: 289.
7. Verbeke CS, Gladhaug IP. Resection margin involvement and tumour origin in pancreatic head cancer. Br J Surg, 2012, 99(8): 1036-1049.
8. Schirmacher P, Büchler MW. Ampullary adenocarcinoma-differentiation matters. BMC Cancer, 2008, 8: 251.
9. Mohamadnejad M, DeWitt JM, Sherman S, et al. Role of EUS for preoperative evaluation of cholangiocarcinoma: a large single-center experience. Gastrointest Endosc, 2011, 73(1): 71-78.
10. Yamaguchi K, Enjoji M, Kitamura K. Endoscopic biopsy has limited accuracy in diagnosis of ampullary tumors. Gastrointest Endosc, 1990, 36(6): 588-592.
11. Noor MT, Vaiphei K, Nagi B, et al. Role of needle knife assisted ampullary biopsy in the diagnosis of periampullary carcinoma. World J Gastrointest Endosc, 2011, 3(11): 220-224.
12. Inoue T, Kitano R, Kobayashi Y, et al. Assessing the diagnostic yield of controllable biopsy-forceps for biliary strictures. Scand J Gastroenterol, 2018, 53(5): 598-603.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

以反复黄疸为临床表现的胆总管下段癌1 例报道并文献复习

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