Late development of bile duct cancer after sphincteroplasty: A ten- to twenty-two-year follow-up study
Late development of bile duct cancer after sphincteroplasty: A ten- to twenty-two-year follow-up study
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DOI：
10.1016/s0039-6060(97)90101-x
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发表时间：
1997-05-01
期刊：
影响因子：
3.8
通讯作者：
Konn, M
中科院分区：
文献类型：
--
作者：
Hakamada, K;Sasaki, M;Konn, M
背景经十二指肠括约肌成形术旨在破坏括约肌纤维，形成终末胆总管十二指肠吻合术。在没有Oddi括约肌的情况下，具有激活的胰液和细菌植物群的肠内容物回流到胆管中并在那里停留很长时间。产生反流的长期影响迄今尚未评估。1973年2月至1984年7月期间，119例连续接受经十二指肠括约肌成形术的患者被纳入本研究。108例患者的术后临床过程可以通过回顾性审查的医院记录进行评价。中位随访时间为18年。108例中8例（7.4%）术后1 ~ 20年发现原发性胆管癌。2例患者并发肝内胆管结石。所有病例均证实括约肌成形术通畅，7例胆汁感染。病理结果显示胆管癌和不同程度的不典型增生性病变的背景下，慢性胆管炎。慢性胆管炎可能是括约肌成形术后胆管癌晚期发展的重要原因。任何接受胆总管十二指肠吻合术的患者都应密切监测晚期胆管癌。
Background. Transduodenal sphincteroplasty is designed to destroy the sphincteric muscle fibers, producing a terminal choledochoduodenostomy. In the absence of Oddi's sphincter, intestinal contents with both activated pancreatic juice and bacterial flora are refluxed into the bile duct and remain there for a prolonged time. The long-term effect of producing the reflux has not been evaluated to date.Methods. One hundred nineteen consecutive patients undergoing transduodenal sphincteroplasty between February 1973 and July 1984 were included in this study. Postoperative clinical courses of 108 patients could be evaluated by means of a retrospective review of the hospital records. Median follow-up was 18 years.Results. Eight cases (7.4%) of primary bile duct cancer were found among the 108 cases at intervals of 1 to 20 years afters sphincteroplasty. Two patients had concurrent hepatolithiasis. The patency of sphincteroplasty was confirmed in all cases, and the bile was infected in seven cases. Pathologic specimens obtained demonstrated cholangiocarcinomas and various degrees of atypical hyperplastic lesions under the background of chronic cholangitis.Conclusions. Chronic cholangitis can be an important causative factor in late development of bile duct cancer after sphincteroplasty. Any patients treated with choledochoduodenostomy should be closely monitored for late cholangiocarcinoma.