胆管内乳头状肿瘤的诊断与治疗

Diagnosis and treatment of intraductal papillary neoplasm of the bile duct

  • 摘要: 胆管内乳头状肿瘤(IPNB)是一类罕见的起源于胆道系统上皮细胞的肿瘤,其预后较胆管癌良好。IPNB可发于胆道树的任何部位,导致胆管扩张和急性胆管炎。该病发病原因不明,与西方国家报道的IPNB患者比较,东亚国家的IPNB患者多合并胆道结石和华支睾吸虫病。根据免疫组织化学染色表现,IPNB可分为4种亚型:胰胆型、肠型、胃型和嗜酸瘤细胞型。其中胰胆型最为常见,合并侵袭性病变最多。无远处转移的患者可行手术切除治疗,手术方式包括胰十二指肠切除术、半肝切除术、肝部分切除术和肝移植,区域性淋巴结清扫亦有必要。

     

    Abstract: Intraductal papillary neoplasm of the bile duct (IPNB) is a rare tumor arising from epithelia of bile duct, with a better prognosis compared with common cholangiocarcinoma. IPNB can occur anywhere along the biliary tree, and cause the dilation of the bile duct and acute cholangitis. Recent large case series of this peculiar disease in the far eastern countries showed greater incidences of hepatolithiasis and clonorchiasis compared with Western series. According to the immunochemistry features, IPNB can be classified into four subtypes, pancreaticobiliary, intestinal, gastric and oncocytic types. The pancreaticobiliary type is the most common and is usually associated with invasive lesions. Patients without distant metastasis can undergo surgical resection, surgical procedures include pancreaticoduodenectomy, hemihepatectomy, segmental liver resection and liver transplantation, and regional lymphectomy is necessary.

     

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