胆管内乳头状粘液瘤的诊治进展

外科研究与新技术 ›› 2015, Vol. 4 ›› Issue (1): 40-43.

胆管内乳头状粘液瘤的诊治进展

周德华,施宝民

同济大学附属同济医院

收稿日期:2015-04-20 修回日期:2015-04-23 出版日期:2015-03-28 发布日期:2015-04-01
通讯作者: 周德华 E-mail:deachzdh@163.com

The advance of Diagnose and Therapy of Intraductal Papillary Mucinous Neoplasm of the Bile Duct

Received:2015-04-20 Revised:2015-04-23 Online:2015-03-28 Published:2015-04-01

摘要/Abstract

摘要： 胆管内乳头状粘液瘤是一种较为罕见的胆管内乳头状肿瘤，近年来报道逐渐增多。主要的表现是粘液瘤分泌过量的黏液蛋白引起阻塞性黄疸，CT及MRCP可见胆道扩张、胆道占位、充盈缺损，胆道镜检查发现大量粘液样胆汁，病理组织活检可以证实。该病良性居多，但也有癌变或者恶性的。局限性病灶多采用手术进行根治性切除，预后较好。无法耐受手术的患者可以采取非手术治疗，但效果有限，预后尚需进一步研究。

关键词: 胆管乳头状粘液性肿瘤, 病理分型, 诊疗进展

Abstract: Intraductal papillary mucinous neoplasm of the bile duct is a rare kind of papillary neoplasm of the bile duct. In the recent years, relative reports have been growing in the number quality. The main clinical manifestation is the obstructive jaundice caused by mucinous proteins secreting by the mucinous neoplasms. With the help of computed tomography and magnetic resonance cholangio paneretography, the bile dilation, the bile occupying and filling-defect can be observed. Through the choledochoscope large amounts of mucous-like gall can be seen. And the pathological tissue biopsy can confirme the diagnosis. This disease is mostly benign but at times malignant. Almost limited lesions are treated by radical excision and prognosis is always be fine, while diffuse lesions prefer the chemotherapy but the effect is poor and the prognosis is not good.

周德华施宝民. 胆管内乳头状粘液瘤的诊治进展[J]. 外科研究与新技术, 2015, 4(1): 40-43.

参考文献

[1]Uchiyama,S.et al. Mucin-producing bile duct tumor of the caudate lobe protruding into the common hepatic duct. [J] Gastrointest Surg, 2007,11(11):1570-2.
[2]CAROLI J., Papillomas and papillomatoses of the common bile duct, Rev Med Chir Mal Foie. 1959;34:191-230
[3]Abraham, S.C., et al., Molecular and immunohistochemical analysis of intraductal papillary neoplasms of the biliary tract. Hum Pathol, 2003. 34(9): p. 902-10.
[4]Jang, K.T., et al., Intraductal papillary neoplasm of the bile duct associated with Clonorchis sinensis infection. Virchows Arch, 2008. 453(6): p. 589-98.
[5]Lim, J.H., et al., Radiological spectrum of intraductal papillary tumors of the bile ducts. Korean J Radiol, 2002. 3(1): p. 57-63.
[6]Zen, Y., et al., Mucinous cystic neoplasms of the liver: a clinicopathological study and comparison with intraductal papillary neoplasms of the bile duct. Mod Pathol, 2011. 24(8): p. 1079-89.
[7]Yang, J., W. Wang and L. Yan, The clinicopathological features of intraductal papillary neoplasms of the bile duct in a Chinese population. Dig Liver Dis, 2012. 44(3): p. 251-6.
[8]Xu, X.W., et al., Laparoscopic resection of synchronous intraductal papillary mucinous neoplasms: a case report. World J Gastroenterol, 2012. 18(44): p. 6510-4.
[9]Yamaguchi, Y., et al., A case of mucin hypersecreting intraductal papillary carcinomas occurring simultaneously in liver and pancreas. Gastrointest Endosc, 2005. 61(2): p. 330-4.
[10]Zalinski, S., et al., Intraductal papillary mucinous tumors of both biliary and pancreatic ducts. J Hepatol, 2007. 46(5): p. 978-9.
[11]Joo, Y.H., et al., A case of mucin-hypersecreting intrahepatic bile duct tumor associated with pancreatic intraductal papillary mucinous tumor. Gastrointest Endosc, 2000. 52(3): p. 409-12.
[12]Choi, S.C., et al., The clinicopathological features of biliary intraductal papillary neoplasms according to the location of tumors. J Gastroenterol Hepatol, 2010. 25(4): p. 725-30.
[13]Lim, J.H., et al., Cyst-forming intraductal papillary neoplasm of the bile ducts: description of imaging and pathologic aspects. AJR Am J Roentgenol, 2011. 197(5): p. 1111-20.
[14]Yaman, B., et al., Biliary intraductal papillary mucinous neoplasia: three case reports. Virchows Arch, 2009. 454(5): p. 589-94.
[15]Nanashima, A., et al., A case of intraductal papillary neoplasm of the bile duct with stromal invasion. Case Rep Gastroenterol, 2008. 2(3): p. 314-20.
[16]Zen, Y., et al., Biliary cystic tumors with bile duct communication: a cystic variant of intraductal papillary neoplasm of the bile duct. Mod Pathol, 2006. 19(9): p. 1243-54.
[17]Jung, G., et al., Long-term clinical outcome of the surgically resected intraductal papillary neoplasm of the bile duct. J Hepatol, 2012. 57(4): p. 787-93.
[18]Kim, B.S., et al., Intrahepatic biliary intraductal papillary mucinous neoplasm with gallbladder agenesis: case report. Surg Laparosc Endosc Percutan Tech, 2012. 22(5): p. e277-80.
[19]Rocha, F.G., et al., Intraductal papillary neoplasm of the bile duct: a biliary equivalent to intraductal papillary mucinous neoplasm of the pancreas? Hepatology, 2012. 56(4): p. 1352-60.
[20]Nakanuma, Y., et al., Multistep carcinogenesis of perihilar cholangiocarcinoma arising in the intrahepatic large bile ducts. World J Hepatol, 2009. 1(1): p. 35-42.
[21]. Valente, R., et al., Simultaneous intraductal papillary neoplasms of the bile duct and pancreas treated with chemoradiotherapy. World J Gastrointest Oncol, 2012. 4(2): p. 22-5.
[22]. Kim HJ1, Yu ES et al., CT Differentiation of Mucin-Producing Cystic Neoplasms of the Liver From Solitary Bile Duct Cysts, AJR Am J Roentgenol. 2014 Jan;202(1):83-91. doi: 10.2214/AJR.12.9170.
[23] Fuks D et al., Intracystic concentrations of tumour markers for the diagnosis of cystic liver lesions, Br J Surg. 2014 Mar;101(4):408-16.
[24] Kentaro Takanami et al.,Intraductal papillary mucininous neoplasm of the bile ducts: multimodality assessmentwith pathologic correlation, Abdom Imaging (2011) 36:447–456
[25]杨丽等，胆管乳头状瘤病研究进展，世界华人消化杂志 2009，7，8; 17(19): 1967-1971
[26]Imvr ios G;Papanikolaou V;Lalountas M;Patsiaoura K Giakoustidis D Fouzas I Anagnostara E Antoniadis N Takoudas D Papillomatosis of intra-and extrahepatic biliary tree:Successful treatment with liver transplantation
[27]Ciardullo MA;Pekolj J;Acuna Barrios JE;Gadano A,Mullen E,Castaing D,de Santinanes E [Multifocal biliary papillomatosis:an indication for liver transplantation]
[28]Dumortier J;Scoazec JY;Valette PJ;Ponchon T Boillot O Successful liver transplantation for diffuse biliary papillomatosis[外文期刊] 2001
[29]Mar ion-Audibe r t AM;Gui l l e t M;Rode A;Barnoud R,Mesnil A,Ducerf C,Bancel B,Pere-Verge D,Mabrut JY,Viale JP,Souquet JC Diffuse biliary papillomatosis:a rare indication for liver transplantation 2009
[30]Beavers KL;Fried MW;Johnson MW;Zacks SL Gerber DA Weeks SM Fair JH Odell P Shrestha R Orthotopic liver transplantation for biliary papillomatosis
[31]Charre L;Boillot O;Goffette P;Geubel A Gigot JF Sempoux C Lerut J Long-term survival after isolated liver transplantation for intrahepatic biliary papillomatosis[外文期刊] 2006
[32]牟一等，内镜下治疗胆管乳头状瘤的价值，中国普外基础与临床杂志2012年1月第19卷
[33] Katabi N1, Torres J, Klimstra DS Intraductal tubular neoplasms of the bile ducts., Am J Surg Pathol. 2012 Nov;36(11):1647-55